Nasya manyasthambha pk014-gdg

By

K.S. ASWINI DEV.

Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences,Karnataka, Bangalore.

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATHI M.D. (PANCHAKARMA)

In

PANCHAKARMA

Under the guidance of

Dr. G. PURUSHOTHAMACHARYULU M.D. (Ayu)

Under the co-guidance of

Dr. SANTOSH . N. BELAVADI M.D. (Ayu)

Post graduate department of Panchakarma. Shri D. G. Melmalagi Ayurvedic Medical College.

Gadag – 582103.

2006.

CLINICAL STUDY ON “ROOKSHASWEDASTHADHACLINICAL STUDY ON “ROOKSHASWEDASTHADHACLINICAL STUDY ON “ROOKSHASWEDASTHADHACLINICAL STUDY ON “ROOKSHASWEDASTHADHACLINICAL STUDY ON “ROOKSHASWEDASTHADHA

NASYAM” IN THE MANAGEMENT OFNASYAM” IN THE MANAGEMENT OFNASYAM” IN THE MANAGEMENT OFNASYAM” IN THE MANAGEMENT OFNASYAM” IN THE MANAGEMENT OF

MANYASTHAMBHA (CERVICAL SPONDYLITIS)MANYASTHAMBHA (CERVICAL SPONDYLITIS)MANYASTHAMBHA (CERVICAL SPONDYLITIS)MANYASTHAMBHA (CERVICAL SPONDYLITIS)MANYASTHAMBHA (CERVICAL SPONDYLITIS)

Ayurmitra

TAyComprehended

Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDIDATE

hereby declare that this dissertation / thesis entitled

“Clinical Study On “Rookshaswedasthadha Nasyam” in the Manage-

ment of Manyasthambha (Cervical Spondylitis).” is a bonafide and

genuine research work carried out by me under the guidance of Dr. G.

Purushothamacharyulu, M.D.(Ayu), Professor & H.O.D, Post gradu-

ate department of Panchakarma and co-guidance of Dr. Santosh.N.

Belavadi M.D.(Ayu), Lecturer, Post graduate department of Panchakarma.

Date:Place: Gadag.

I

K.S. Aswini Dev

CERTIFICATE BY THE CO- GUIDE

This is to certify that the dissertation entitled “Clinical Study On

“Rookshaswedasthadha Nasyam” in the Management of Manyasthambha

(Cervical Spondylitis).” is a bonafide research work done by

K.S. Aswini Dev. in partial fulfillment of the requirement for the degree of

Ayurveda Vachaspathi. M.D (Panchakarma).

Date:

Place:Gadag. Dr. Santosh. N. Belavadi. M.D. (Ayu).

Lecturer,

Post graduate Department of Panchakarma.

ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF

THE INSTITUTION


Rookshaswedasthadha Nasyam in the Management of Manyasthambha

(Cervical Spondylitis)” is a bonafide research work done by K.S. Aswini Dev

under the guidance of Dr. G. Purushothamacharyulu, M.D. (Ayu). Professor &

H.O.D, Postgraduate department of Panchakarma and co-guidance of

Dr. Santosh.N. Belavadi M.D. (Ayu), Lecturer, Post graduate department

of Panchakarma.

Dr. G. Purushothamacharyulu, M.D. (Ayu). Dr. G. B. Patil.

Professor & H.O.D. Principal.

Post graduate department of Panchakarma.

SHRI D. G. MELMALAGI AYURVEDIC MEDICAL COLLEGE,POST GRADUATE DEPARTMENT OF PANCHAKARMA.

CERTIFICATE BY THE GUIDE


Rookshaswedasthadha Nasyam in the Management of Manyasthambha

(Cervical Spondylitis)” is a bonafide research work done by

K.S. Aswini Dev in partial fulfillment of the requirement for the degree of

Ayurveda Vachaspathi. M.D (Panchakarma).

Date:

Place:Gadag. Dr. G. Purushothamacharyulu. M.D. (Ayu).

Professor & H.O.D.

Post graduate Department of Panchakarma.

SHRI D. G. MELMALAGI AYURVEDIC MEDICAL COLLEGE,POST GRADUATE DEPARTMENT OF PANCHAKARMA.

COPYRIGHT

Declaration by the candidate

I hereby declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall have the rights to preserve, use and

disseminate this dissertation / thesis in print or electronic format for

academic / research purpose.

Date:

Place:Gadag.

© Rajiv Gandhi University of Health Sciences, Karnataka.

K.S. Aswini Dev.

I

ACKNOWLEDGMENT By the god’s grace and blessing of elders, I would like to express my gratitude towards the personalities who helped me during my course of study. I express my obligation to my honourable guide Dr. G. Purushothamacharylu M.D. (Ayu) H.O.D. PG Department of panchakarma, for his critical suggestions and expert guidance for the completion of this work. I am extremely grateful and obliged to my Co-Guide Dr. Santosh. N. Belavadi, Lecturer, for his guidance and encouragement at every step of this work. I express my deep gratitude to Dr. G.B. Patil, Principal D.G.M.A.M.C, Gadag, for his encouragement as well as providing all necessary facilities for this research work. I express my sincere gratitude to Dr. P. Shivaramadu M.D. (Ayu), Professor and Dr. Shashidhar.H. Doddamani M.D. (Ayu), for their sincere advices and assistance. I express my gratitude to Dr. R.V. Shettar M.D. (Ayu), Dr. Samudri M.D.(Ayu) for their encouragement as well as suggestions for this research work. I express my sincere gratitude to Dr. Varadacharylu M.D. (Ayu), Dr. M.C. Patil M.D. Dr. Mulagund M.D. Dr. K.S.R. Prasad M.D. Dr. Dilipkumar M.D. Dr. Kuber sankh M.D. Dr. G. Danappa gowda M.D. Dr. U.V. Purad M.D. Dr. B.G. Swami M.D. Dr. J. Mitti M.D. Dr. Nidugundi M.D. and other P.G. Staff for their constant encouragement. I am thank full to Sri M.V. Mundinamani (Librarian) Sri Tippana gowda (Lab-Technician) Basavaraj (X-Ray Technician), Sri Chaitrakumar (Computer operator) for their help during my course of study. I express my sincere thanks to my colleagues and friends Dr. Udaykumar, Dr. Lingareddy Biradar, Dr. Krishnakumar, Dr. Chandramouliswaran. Dr. Ratnakumar, Dr. Prasanakumar, Dr. Ashok, Dr. Vijay Hiremath, Dr. Manjunath Akki, Dr. Suresh Akkandi, Dr. Subin Vaidyamadom, Dr. Satheesh Varrier, Dr. Febin .K. Dr. Ranjith, Dr. Shajil, Dr. Shyju ollakode, Dr. V.M. Hugar, Dr. Venka reddy, Dr. Kalmat, Dr. Jayraj Basarigidad, Dr. Kendadamath, Dr. Madhushree, Dr. Shiba, Dr. Payappagouder, Dr. Budi, Dr. Nataraj, Dr. Adarsh, Dr. Uday Ganesh, Dr. Kumbar, Dr. Mukta.H. and other P.G Scholars for their support. I lay my deep respects to my grand parents Late: Sri Kuttan Pillai, Sumathi kutty Amma, Late: Raghavan Pillai and Ponnamma for their elderly blessings upon me. I also thankful to my uncles Mohanan. Devananthan, Suresh kumar, Madhukunar, Mohana krishan, Dr. Harikrishnan and aunts chandrika, Geetha, smitha, Sheeja, Suja, Sindhu, Prameela for their moral support. I pray homage to my dearest uncle Late Shri Bhankara Pillai for his love affection.

II

I would like to put the support and inspiration provided by Dr. M.N Raveendran Nair (Retd. Principal) Dr. M.S. Suseelappan (Retd. Principal) Dr. Sukumaran Nair (Rtd. Principal), Dr. Keshavadas M.D. (Ayu), Dr. P.S. Gopi Rtd. D.M.O (is M Kerala), Brahmasree Astavaidyan Vaidyamadam cheriya Narayana Nambudiri, Dr. Rajukutty, Dr. Sahadevan, Dr. Mathew’s Vempilly, Dr. Mustattakamal, Dr. A. Satyanarayana, Smt. P.B Pankaja, Dr. Krisha Kutty Nair (Rtd. Superdient of Panchakarma, Dr. Rajini sunel. I also acknowledge the support and inspiration provided by my teachers Dr. Vasadeva Redder, Dr. Brahma, Dr. S. Swaminatan, I also thank Sri Habib Katib and family for the support and acknowledgment provided during my stay at Gadag. I acknowledgment my parents for their whole hearted consent to participate in his clinical trial. I express my thanks to all the persons who have helped me directly and indirectly with apology for my inability to identify then individually. Finally I express my deep love and affection to my respected parents Sri Dr. R. Sasidharan Pillai (Retd. Govt: Medical Officer) and Smt. Girija S. Pillai who are the prime reasons for all my success.

(K.S. Aswini Dev)

III

LIST OF ABBREVIATIONS

⇒ A. H. – Ashtanga Hridaya.

⇒ B. P. – Bhavaprakasha

⇒ C. S. – Charaka Samhita.

⇒ G. R. – Good response.

⇒ M. R. – Moderate response.

⇒ N. R. – No response.

⇒ P. R. – Poor response.

⇒ S. S. – Sushruta Samhita.

IV

ABSTRACT

The present study and clinical study on the Rookshaswedasthadha Nasyam in the

management of Manyasthambha is focused on the techniques of pinda sweda and

additive effect of Nasya and a common disorder of Manyasthambha. Rookshasweda and

Nasya is believe to have a note worthy role in the management of such inflammatory and

degenerative condition by imparting strength to the cervical spine, its related structures

and nervous system.

The objective of the study are 1) To evaluate the efficacy of Rooksha sweda in the

management of Manyasthambha. (Cervical spondylitis) 2) To evaluate the efficacy of

Rooksha sweda and Nasya in the management of Manyasthambha (Cervical spondylitis).

3) To evaluate the comparative efficacy of both these treatment groups in the

management of Manyasthambha (Cervical spondylitis)

The aim of the study was to find out the effect of Rooksha sweda and Nasya in

the management of Manyasthambha and to check the advantage of Nasya over Rooksha

sweda in Managing the same disease therefore two groups were made. The study design

selected for the present study was prospective comparative clinical trial.

The result of the study confirmed that Rookshasweda has highly significant in

Ruk, Graha, Extension and Lateral flexion of neck in group A. In group A Muscle

strength and Rotation showed no significant Result.

In group B muscle strength showed no significant result, and rest of the

parameters showed highly significant results. This increased significance of the

parameters is may be due to the additive effect of Nasya along with Rooksha sweda.

V

In the classic, the Treatment is told as Rooksha sweda and Nasya where we

consider Manyastambha in the doshic level as vata and kapha are the two main factors

involved in the pathogenesis of Manyasthambha. Here the pain and stiffness are two

symptoms present in the disease which can be attributed the vata and kapha dosha

lakshna Rooksha sweda is told for srotoshodhana ther by subside the vitiated kapha

which is in the Manya predesha and for this purpose, Rooksha sweda by Kolakulathadi

choorna is done which relieves the pain and stambatwa.

Manyasthambha being one of the urdwajatru gatha vikara and especially dhatu

kshayajanya vata roga hence Brumhana type of nasyakarma is more beneficial.

Brumhana Nasya karma has been selected for the study become the disease

Manyasthambha is inflammatory and degenerative in origin and Urdwajatagata vata

vyadhi. Hence nasyakarma with Mahamasha thaila is best advisible to palliate the

disease which helps to set right the disease as it being santarpana type of chikitsa which

prepared with vatahara drugs.

Key words: Rooksha sweda, Kolakulathadi Choorna, Manyasthambha, Cervical

spondylitis, Nasya, Mahamasha taila, etc.

Table of Contents Chapter Page No.

1 Introduction 1-4

2 Objectives 5-7

3 Review of literature 8-103

4 Methods 104-131

5 Results 132-170

6 Discussion 171-182

7 Conclusion 183-184

8 Summary 185

9 Bibliographic References

10 Annexure

i

LIST OF TABLES LIST OF TABLES Page No.1. Table Showing Classification of Nasya according to Various Acharya 11 2. Table Showing the dosage schedule for sneha nasya is as below 16 3. Table Showing dosage schedule according to Sushruta. 17 4. Table Showing indications of Nasya according to season 18 5. Table Showing the time schedule of Navana Nasya 18 6. Table Showing dose of Shirovirechana 20 7. Table Showing the indication of avapida Nasya 20 8. Table Showing the length of dhuma yantra nadi 22 9. Table Showing drugs used fo Dhuma nasya 22 10. Table Showing various Timings for Pratimarsha Nasya 24 11. Table Showing the contra Indications of Nasya mentioned in

Brihattrayi 29

12. Table Showing time schedule in different seasons 31 13. Table Showing time schedule in Doshaja Vikara 31 14. Table Showing the Course of Nasya karma 32 15.

Table Showing The Dosage of Nasya Karma 33

16. Table Showing Nasya Yantra

35

17. Table Showing Samyaka Yoga Lakshana

38

18. Table Showing ayoga Lakshana 39 19. Table Showing atiyoga Lakshan 40 20. Table Showing the properties, action and predominance of

mahabhootas of swedana dravyas 46

21. Table Showing the persons and diseases that are fit for swedana. 47

22. TableShowing the persons and diseases those are unfit for Swedakarma.

48

23. Table Showing the lakshanas to be observed on the patient 50

24. Table Showing the Atiswinna lakshanas on the patient 51

25. Table Showing types of sweda 53

26. Table Showing the different layers of twak 73 27. Table Showing the incidence of Nidana of Manyasthambha according

to different Acharyas 89

28. Table Showing Level of disc herniation 99 29. Table Showing the Pathyaapathyas in Vatavyadhi 101

30. Table Showing chikitsa of Manyasthamba according to different Acharyas

102

31. Table Showing the Rasa, guna, veerya, vipaka, and dosha karma of kolakulathadi choorna.

111

32. Table Showing the Table of Mahamasha taila 112 33. Table Showing distributions of patients by age Groups. 133 34. Table Showing distributions of patients by sex 134 35. Table Showing distributions of patients by Religion 135 36. Table Showing distributions of patients by Occupation 136 37. Table Showing distributions of patients by Economical status 137

ii

38. Table Showing distributions of patients Dietary habit 138 39. Table Showing distributions of patients by Agni 139 40 Table Showing distributions of patients by Koshta 140 41 Table Showing distributions of patients by Nidra 141 42 Table Showing distributions of patients by Vyasana 142 43

Table Showing distributions of patients by Deha-prakriti 143

44 Table Showing distributions of patients by Satmya 144 45 Table Showing distributions of patients according to chronicity of the

disease. 145

46 Table Showing distributions of patients by Ahara Nidana: 146 47 Table Showing distributions of patients by Vihara Nidana: 147 48 Table Showing distributions of patients by Manasika Lakshana: 148 49 Table Showing Distributions of patients by different grades of RUK 149 50

Table Showing response of patients by different grades of RUK 150

51 Table Showing distributions of patients by Different grades of Graha 151 52 Table Showing response of patients by different grades of Graha 152 53 Table Showing distributions of patients by different grades of (Passive

neck flexion) 153

54 Table Showing response of patients of patient by different grades of (Passive neck flexion)

154

55 Table Showing distributions of patients by different grades of muscle strength

155

56 Table Showing the over all treatment Response in patient of different grades of Muscle strength in both the treatment Groups (A&B):

156

57 Table Showing distributions of patients by different grades of Mobility gradings (flexion)

157

58 Table Showing the over all treatment Response in patient of different grades of Mobility grading (flexion)

158

59 Table Showing distributions of patients by different grades of Mobility extension

159

60 Table Showing the over all Response in patient of different grades of Extension

160

61 Table Showing distributions of patients by different grades of Lateral flexion

160

62 Table Showing the over all Response in patient of different grades of Lateral flexion

161

63 Table Showing distributions of patients by different grades of Rotation in both the treatment Groups (A&B):

161

64 Table Showing the over all Response in patient of different grades of Rotation

162

65 Table Showing distributions of patients by different grades to Over all Response

162

66 Table Showing Overall response of each parameter 163 67 Table Master Chart of Subjective and Objective Parameters. 164 68 Table Showing Statatical analysis of Group A 165 69

Table Showing Statatical analysis of Group B 165

70 Table Showing Comparative statistical analysis of both Groups (A & B).

166

iii

71 Table Showing the response of Nasyakarmukata in Group A. 167 72 Table Showing the response of Nasyakarmukata in Group B. 168 73 Table Showing Statatical analysis of Nasyakarmukata in Group A 168 74 Table Showing Statatical analysis of Nasyakarmukata in Group B 168 75 Table Showing the response of Swedakarmukata in Group-A. 169 76 Table Showing the response of Swedakarmukata in Group-B. 169 77 Table Showing the study of Sweda kaarmukata parameters of Group-A. 170 78 Table Showing the study of Sweda kaarmukata parameters of

Group-B. 170

LIST OF FIGURES PHOTOGRAPHS AND GRAPHS

LIST OF TABLES Page No.1. Figure Showing section of skin 75 2. Figure Showing Cervical vertebrae (C1-C4) Postrio-superior view 80 3. Figure Showing Cervical vertebrae (C2-T1) Right lateral view 81 4. Figure Showing the Ingredients of Kolakulathadi choorna 104 5. Figure Showing the treatment procedures of Nasya and Rookshasweda 123 6 Graph Showing distributions of patients by age Groups. 133 7 Graph Showing distributions of patients by sex 134 8 Graph Showing distributions of patients by Religion 135 9 Graph Showing distributions of patients by Occupation 136 10 Graph Showing distributions of patients by Economical status 137 11 Graph Showing distributions of patients Dietary habit 138 12 Graph Showing distributions of patients by Agni 139 13 Graph Showing distributions of patients by Koshta 140 14 Graph Showing distributions of patients by Nidra 141 15 Graph Showing distributions of patients by Vyasana 142 16

Graph Showing distributions of patients by Deha-prakriti 143

17 Graph Showing distributions of patients by Satmya 144 18 Graph Showing distributions of patients according to chronicity of the

disease. 145

19 Graph Showing distributions of patients by Ahara Nidana: 146 20 Graph Showing distributions of patients by Vihara Nidana: 147 21 Graph Showing distributions of patients by Manasika Lakshana: 148 22 Graph Showing Distributions of patients by different grades of RUK 149 23 Graph Showing distributions of patients by Different grades of Graha 151 24 Graph Showing distributions of patients by different grades of (Passive

neck flexion) 153

25 Graph Showing distributions of patients by different grades of muscle strength

155

26 Graph Showing distributions of patients by different grades of Mobility gradings (flexion)

157

27 Graph Showing distributions of patients by different grades of Mobility extension

159

28 Graph Showing distributions of patients by different grades of Lateral flexion

160

29 Graph Showing distributions of patients by different grades of Rotation in both the treatment Groups (A&B):

161

30 Graph Showing distributions of patients by different grades to Over all Response

162

iv

Introduction

There are many marvels created by the human being but the greatest marvel is

the human being itself. Human, being superior out of four kinds of living beings

Swedaja, Andaja, Audbhija and Jarayuja, is the conglomeration of the five basic

entities i.e., Panchamahabhutas and is the subject of the treatment as he is associated

with miseries.

Body is formed by three Dosha viz. Vata, Pitta and Kapha. They are present in

three phases, as the establishment, existence and extinction. These Doshas

respectively prop up the body like Anila (air), Surya (sun or fire ) and Soma (moon or

water), which support the cosmic functions like Visarga (releasing the energy),

Aadana (drawing strength) and vikshepa (by diffusing). The body connot survive

without Kapha, Pitta and Vata. The Tridoshas eternally present and support the body

as vital forces in their normalcy, import development strength, complexion and

cheerfulness to the body.

Ayurveda is the rich storehouse of time-tested and effective recipes for the

treatment of several obstinate and otherwise incurable diseases. More important than

these recipes are the specialized therapies, which while curing such diseases

strengthen the immune system in the body and help in the preservation of positive

health. These specialized therapies in Ayurveda are called as Panchakarmas. It is no

wonder that the scientists and physicians in India and abroad are evincing deep

interest in the classical form of Ayurvedic treatment. Panchakarma therapy primarily

aims at cleansing the body of its accumulated impurities and nourishing the tissues.

Once this is achieved, it becomes very easy to rejuvenate the tissues and prevent the

process of ageing. This helps the individual to lead a disease free old age and he/she

1

“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha

Introduction

becomes capable of serving the society with his/her accumulated experience without

any mental disability and physical decay.

The term ‘Panchakarma’ literally means five-fold therapy. The word ‘Pancha’

has a meaning ‘Vistara’ (elaborate) also. Thus, it implies the meaning elaborate

procedures. Both the meanings are really true in their sense. The therapies that are

included under this collective term are Vamana karma, Virechana karma, Nirooha

basti, Anuvasana basti and Nasya karma. Sushruta’s school, which deals with surgery

primarily, includes Rakthamokshana in the place of Anuvasana basti.

It is necessary at this state to make it clear that these Panchakarmas do not

imply simple administration of emesis, purgation, enema or nasal drops as is

conventionally understood. Elaborate methods are described for the preparation of

these therapies, their administration, preparation of the individual prior to the

administration of these and the management of the patient after the therapy is

administered.

Nasya is an important therapeutic procedure as many of the courses of

Ayurvedic treatment1. It comes under the Panchashodhanakarmas2. It is more or less

essential in all Urdhwa jathru vikaras3. Nasya is effective not only for inducing

immediate results but also serves as a permanent cure.

Nasya is described as having a significant role among Panchakarmas as it

does. The important action of Shirah shodhana4 (clearing the channels of head) by

clearing the doshasamghata deep rooted in the channels of indiriyas situated in the

Shiras.

2


Introduction

During the course of time, some therapies have been developed in Ayurveda.

Apart from curing some of the obstinate and otherwise incurable diseases, these

special therapies help in rejuvenating the body. If used periodically, they prevent the

ageing process while simultaneously preventing the manifestation of diseases. Thus

these therapies, apart from their utility as preparatory measures for the Panchakarmas

are specialized therapies in their own merit.

Among these modified therapies, choorna Pinda sweda is the most important

technique of rooksha sweda. For this rooksha sweda, a compound called

kolakulathadi choorna which is mentioned by charka is used and prepared by

pounding all the drugs and made into a pottali for swedana purpose. A successfully

employed rooksha sweda is believed to help to a great extent, the patients suffering

from different neuromuscular disorders and also several systemic diseases.

Manyastambha is a vataja nanatmaja vyadhi the symptoms may include Ruk

& Sthamba. The most common symptom is pain in the neck, worsening with exertion

and relieved, in the early stages, by rest. This pain often radiates down to the hand,

with the fingers becoming numb due to compression of the nerves that innervate the

upper extremity. The brachial plexus is affected. The trapezius area becomes tender

and painful. A nodule can form in the muscle due to chronic pressure. The symptoms

of cervical cord compression can sometimes be severe. The pain radiates down the

right or left arm to the fingers, to the chest and shoulder blades depending on which

side the nerve root is involved. It can become continuous, making movements painful

and limited. If the cervical vertebrae become unstable, the danger of cord

3


Introduction

compression is imminent and, in some cases, fusion of the bones may be warranted.

But this is rare7.

Vata disorders are dealt by Acharyas as Vata Vyadhi includes the above-

discussed spinal originative problems, especially cervical Spondylitis as

“Manyastambha”. Truly, the Manyasthambha is one of the Vatajananatmaja Vyadhi,

a disease referred to the Siras in the neck region. Even though Manyasthambha is a

condition pertaining to the veins of the neck (greevagata siras) with its signs and

symptoms resembles the cervical Spondylitis.

Vatavyadhi in general & manyastambha in particular is treated with swedana.

The chapter on the treatment of manyastambha specifically emphasizes on the

adoption of rooksha sweda and nasya8abc. It is because in the initial stages of

Manyasthambha there is vata avarana by Kapha which in later turns out to be a kevala

Vataja vayadhi so in order to relieve the obstructing Kaphadosha rooksha sweda is

done with kolakulathadi choorna9.

As Nasya is stated to be the best for Urdhwajathrugatavikaras and

manyasthambha being one among them is practiced here. So Rookasweda and Nasya

is believed to have a note worthy role in relieving the inflammatory a condition and

stambatwa with in the cardinal feature of manyastambha. Therefore, this study has

been undertaken as an attempt to help the patients suffering from manyastambha in

our society and also to evaluate the efficacy of these treatment modalities.

4


Objectives

5

Need for the study:

In Manyastambha, in the initial stages there in vata avarana by kapha. So inorder

to relieve the avarana, rooksha sweda is done. For this purpose, kolakulathadi choorna is

used which relieves the pain & stambhatwa.

Nasya is an another treatment modality explained by our acharyas in the

management of Manyasthambha. Nasya is stated as the best remedial measure for the

treatment of the diseases of Urdwajatru and manyastambha being one among them. So

for the purpose of Nasya Mahamasha taila mentioned by chakradatta is taken for the

study10.

Manyasthambha (cervical spondylitis) is explained as one of the vataja nanatmaja

vyadhi5. This diseasse is having a prevalence of 0.1 –1% of the general population with a

male to female ratio of 3:1 & more commonly affects population in the productive period

of life6.

In this contemporary system of medicine either conservative or surgical treatment

is done. Treatment usually is conservative, with nonsteroidal anti-inflammatory drugs,

physical modalities,

Ayurveda the age-old Indian system of medicine advocates a reliable management

for the diseases with due consideration to protect the normal health based on Tridosha

theory, treating the disease with highly efficacious and easily available drugs.

Anti inflammatory, Ama Dosha and disease modifying anti rheumatic drugs are

the drugs of choice in contemporary system of medicine. Fortunately all the analgesics

are liable to many side effects particularly in prolonged use.


Objectives

6

Ayurvedic approach to the Manyasthambha is to retard the inflammatory and

degeneration process and strengthening the Dhatus. Pacifying the Vata Dosha has special

importance in the management of any degenerative phenomenon.

Nasya is described as a significant Shodhana therapy as it has the important action

i.e. clearing the channels of head (Shirah Shodhana) by cleansing the Dosha which is

deep rooted in the channels.

In recent and past, Ayurvedic scientists at various centers with an aim to study the

Manyasthambha and to evolve safer and economical medicaments for it, have carried out

several experimental and clinical studies. The works are successful to some extent to

relieve pain and stiffness, common complaints of this condition.

• In 1992, S. Hebbar from G.A.M.C. Mysore, worked on Manyastambha with

special reference to its management by Nasya.

• In 1994, Vijaya Lakshmi from G.A.M.C. Mysore, worked on Medical

management of cervical Spondylitis.

Only few works were carried out related to the present topic .In the classics the

line of treatment was told as Rooksha Sweda and Nasya. Much of Inflammation is seen

only at the initial stage and not at the later stage .The later stages can be named as

degenerative phases. Rooksha Sweda11 is applicable only in the inflammatory stage,

whereas in the degenerative phase Brumhana Nasya and Vata pacifying drugs are more

effective12.

Rooksha sweda and Nasya are the simple techniques and ingredients are easily

available & economical. Also these are indicated in the management of Manyasthambha

and have no proven adverse effects. This study was intended to assess the efficacy of the


Objectives

7

Rooksha sweda and Nasya techniques in the management of this disease and to compare

the efficacy of Rooksha sweda with that of Nasya. So the present study, Clinical Study

on “Rookshaswedasthadha Nasyam” In the management of Manyasthambha

(Cervical Spondylitis) was taken.

Objectives of the study

To evaluate the efficacy of Rooksha sweda and Nasya in the management of

Manyasthambha. (Cervical Spondylitis)

To evaluate the efficacy of Rooksha sweda in the management of

Manyasthambha (Cervical Spondylitis).

To evaluate the comparative efficacy of both these treatment groups in the

Management of Manyasthambha (Cervical Spondylitis).


Historical review of Nasya

HISTORICAL BACKGROUND OF NASYA KARMA

Seeds of knowledge are imbibed in Veda. Veda’s are ancient source of

knowledge. There is description of health and disease related topics in a patchy form in

all Veda but proportion of such topics is significant in Atharvaveda. Hence Ayurveda is

considered as a subset of Atharvaveda. It is natural that accumulation of knowledge of

any topic occurs gradually and same is the case with Nasya karma, which has developed

since Vedic era to Modern era. Before the historical review of Nasya that of Nasa through

which it is given would be handy.

DESCRIPTION OF NASA IN VEDA

Rigveda : There is indication of a word Nasa in a Mantra

“Yen Ygnasta yala sapla …………..”

Yajurveda : While describing the Indriyas, there is mention of two Netra, two Karna,

two Nasika Chhidra and Jihva.

Atharvaveda : Nasa is described among nine chhidras and Indriya.

“Ashtachakra, Navadwara…….”

“Shirshaklima shirshamayana ………..”

Bhagvad Gita : While describing Indriyas, the Nasa is mentioned.

“Navadvara Purva dehi neva …….”

DESCRIPTION OF NASYA IN ANCIENT TEXTS

Rigveda : There is a mantra in Rigveda in which eradication of Roga is mentioned by

routes of Nasa (Nostrils), Chibuka (Chin), Shira (Head), Karna (Ear), and Rasna

(Tongue). This can be considered as a primitive picture of Nasya Karma.

Krishna Yajurveda, Shatpatha Brahmana, Upanishad: In these texts, the term Nasya

karma has been used frequently. 8


Historical review of Nasya

Ramayana : In Valmiki Ramayana, when Laxman became unconscious by the blow of

Meghanada, Vaidya Sushena administered the juice of Sanjivani through nasal route

bringing him to consciousness instantaneously.

Bauddha Kala : “Jeevaka” the famous Vaidya of Bauddha kala had utilized Nasya

karma in many cases such as

1) In Shirahshoola, he prescribed Nasya of medicated ghrita to the wife of Shreshthi

of Saketa Nagar.

2) Once, when Jeevak wanted to give Virechana to Lord Buddha, he gave him

aushadhi by nasya for Virechana.

Vinaya Pitika : In this book, it is mentioned that one utpala hasta of Nasya has potency

to induce 10 vegas of Virechana.

Samhita Kala : Literature written during this period is the heart of ayurvedic literature.

In all the Samhita, Nasya karma has been elaborately described especially in Charaka

Samhita, Sushruta Samhita and Ashtanga Samgraha. The research conducted on this

therapy was at such a height that it was used to achieve expected sex of foetus. Nasya

karma is utilized in treatment of many diseases in Brihattrayi such as in Charaka, in

chikitsa of Jwara, Raktapitta, Kustha, Rajyakshama, Unmada, Apasmara, Shwayathu,

Hikka, Shvasa, Kasa, Visha, Trimarmiya, Vata vyadhi, Trimarmiya siddhi etc,. In

Sushruta Samhita, in Chiktisa of Dwivraniya, Sadyovrana, Bhagandar, Vata Vyadhi,

Mahavata Vyadhi, Kustha, Udara, Granthi, Apachi, Arbuda ganda, Vriddhi, Upadamsha,

Shlipada, Kshudra Roga, Mukha Roga etc, . In Ashtanga Hridaya, in Chikitsa of Jwara,

Raktapitta, Shvasa Hikka, Rajyakshama, Chhardi, Hridaroga, Trishna, Madatyaya,

Shvitra, Krimi, Vata Vyadhi etc,.

9“Rooksha swedasthadha Nasyam” in the Management of Manyasthambha

Nasya karma

10

Etymology of Nasya Karma

In Sanskrit language each word is derived from a specific dhatu and each dhatu

bears an inherent meaning which is the crux of the word. The derivation of the word

Nasya is from “Nasa” dhatu. It conveys the sense of Gati – motion. Vyapti bears the

meaning pervasion. Here, the Nasa dhatu is inferred in sense of nose. According to

Vachaspatyam word “Nasata” means beneficial for nose.

In context of Ayurveda, the word Nasya suggests the nasal route for

administration of various drugs. As per Acharya Sushruta, administration of medicine or

medicated oils through the nose is known as Nasya13. Arunadatta and Bhavaprakasha

opines that all drugs that are administered through the nasal passage are called Nasya14.

Sharangadhara and Vagbhatta15 also hold the same view.

Synonyms :

• Prachchardana

• Shirovirechana

• Shirovireka

• Murdhavirechana

• Navana

• Nastaha Karma

Amongst the various synonyms of Nasya karma Shirovirechana, Shirovireka and

Murdhavirechana are suggestive of elimination of Doshas from the Shira or parts situated

above the clavicle i.e. Prachchardana, whereas the terms Nastaha and Navana indicates

site of administration.


Nasya karma

11

CLASSIFICATION OF NASYA KARMA :

Nasya is classified in various ways by different Acharya. Each classification has

its own salient features and each is done with different angles. Classification according to

various Acharya is described in a tabular form as below.

Table No.1 Showing Classification of Nasya according to Various Acharya

No Name of Acharya Classification

1 Charaka According to mode of action - Rechana, Tarpana, Shamana

According to the method of administration –

Navana, Avapidana, Dhmapana, Dhuma, Pratimarsha

According to various parts of drugs utilized –

Phala, Patra, Mula, Kanda, Pushpa, Niryasa, Twaka

2 Sushruta Shirovirechana, Pradhamana, Avapida, Nasya, Pratimarsha

3 Vagbhatta Virechana, Brimhana,

Shamana

4 Kashyapa Brimhana, Karshana

5 Sharangadhara Rechana, Snehana

6 Bhoja Prayogika, Snaihika

7 Videha Sangya Prabodhaka,

Stambhana,


Nasya karma

12

CHARAKA’S CLASSIFICATION OF NASYA :

According to Charaka the Nasya is of five types viz. Navana, Avapidana,

Dhmapana, Dhuma and Pratimarsha16.

Navana is further divided in to Snehana and Shodhana, Avapidana into Shodhana

and Stambhana, Dhuma into Prayogika, Vairechanika and Snaihika while Pratimarsha is

divided into Snehana and Virechana.

The above-mentioned five types of Nasya are regrouped according to their

pharmacological action into three groups viz. – Rechana, Tarpana and Shamana17.

Charaka has also mentioned 7 types of Nasya according to parts of the drugs to be used

in Nasya karma viz. – Phala, Patra, Mula, Kanda, Pushpa, Niryasa, Twak18.

Nasya

According to the action of Nasya therapy

Navana Avapidana Dhmapana Dhuma Pratimarsha

Snehana Shodhana Prayogika Snaihika Vairechanika

Shodhana Stambhana Snehana Virechana

Shamana Tarpana Rechana

According to various parts of the drugs utilized in Nasya therapy

Phala Patra Mula Kanda Pushpa Niryasa Twaka


Nasya karma

13

CLASSIFICATION OF NASYA ACCORDING TO SUSHRUTA

According to Sushruta, Nasya is of 5 types viz. Nasya, Avapida, Pradhamana,

Shirovirechana and Pratimarsha. These 5 types of Nasya are further classified according

to their functions into two groups viz. Shirovirechana and Snehana19.

Shirovirechana, Avapida and Pradhamana are used for Shirovirechana purpose.

i.e. for the elemination of morbid Dosha from Shira while Pratimarsha and Nasya may

be used for Snehana20.

Nasya

Shirovirechana Snehana

Shirovirechana Pradhmana Avapida Nasya Pratimarsha

VAGBHATTA’S CLASSIFICATION OF NASYA

Ashtanga Samgraha has mainly classified Nasya according to its effect viz.

Virechana, Brimhana and Shamana21. Snehana and Brimhana Nasya have been further

subdivided according to the doses into two groups i.e. Marsha and Pratimarsha22.

Avapida nasya may be given for both Virechana and Shamana while Pradhamana

Nasya is given only for Shirovirechana.

Ashtanga Hridaya has mainly classified Nasya in 3 types viz. Rechana, Brimhana

and Shamana23.


Nasya karma

14

Nasya

KASHYAPA’S CLASSIFICATION OF NASYA

According to Kashyapa Samhita, Nasya has been classified into two groups i.e.

Brimhana and Karshana. These two types are also known as Shodhana and Purana

Nasya24ab.

Virechana Brimhana Shamana

Sneha Nasya According to Dose

Murdha Virechana

Pradhamana

Avapida Pratimarsha Marsha

Nasya

Brimhana Karshana (Shodhana) (Purana)


Nasya karma

15

SHARANGADHARA’S CLASSIFICATION OF NASYA

Sharangdhara has also classified Nasya according to their functions into two

groups viz. Rechana and Snehana. Rechana Nasya is further subdivied into Avapida and

Pradhamana while Snehana Nasya is subdivided into Marsha and Pratimarsha25abc.

Nasya

Rechana Snehana

Pradhmana Marsha Avapida Pratimarsha

VIDEHA’S CLASSIFICATION OF NASYA

Videha has stated two types i.e. Sanjyaprabodhaka and Stamabhana26

Nasya

Sanjya Prabodhaka Stambhana

It is clear from the above discription that two types of classification of Nasya Karma

are available in Ayurvedic literature. One is based on the pharmacological actions viz.

Rechana, Tarpana etc. Other is based on the preparation of drug and the method of its

application e.g. Dhmapana (Powder is blowed) Avapida (Extracted Juice is used) Dhuma

(Smoking through nose).


Nasya karma

16

Apart from classification on above basis other criteria are also described as follows :

♦ Classification according to preparation e.g. Avapida nasya which indicates the use

of expressed juice:

♦ Classification according to the dose to be dropped into the nostrils e.g. marsha

and pratimarsha described by Acharya Vagbhatta.Considering by par the

classification of Charaka as gold standard we will have detailed description of

each type.

NAVANA NASYA

Navana is one of the important and well applicable type of Nasya karma.

Method : In Navana, the drops of medicated oil or ghee are administered.

Instrument : For administration of Sneha in nostrils, use of Pranadi (Pipette or dropper)

is described by Acharya Charaka.

Classification : It is classified in to two types. Snehana Nasya, hodhana Nasya

Snehana Nasya : It enhances the strength of all dhatus and is used as dhatu poshaka i.e.

nutritive for dhatu.

Table No.2. The dosage schedule for sneha nasya is as below27

1 Hina matra 8 drops in each nostril

2 Madhyama matra 16 drops in each nostril (Shukti Pramana)

3 Uttama matra 32 drops in each nostril (Panishukti Pramana)

According to Bhoja, Matra of Prayogika sneha nasya is 8 drops, while matra of

Snahika Nasya 16 drops. According to Doshabala quantity can be doubled or tripled.


Nasya karma

17

Benefits of Sneha Nasya :

It is used for the Snehana in the complaint of feeling of head lightness. It gives

strength to neck, shoulder and chest and improves eyesight.

Indications of Sneha Nasya :

Sneha Nasya can be given in the following conditions :

Vatika Shirahshula, Keshapata, Dantapata, Shmashrupata, Tivrakarnashula,

Timira, Nasaroga, Mukhashosha, Avabahuka, Akalaja Valita, Akalaja Palita,

Darunaprabodha and Vatapittaja Mukharoga28.

Shodhana Nasya

Sushruta’s Shirovirechana type is included in Shodhana type of Navana Nasya. It

eliminates the vitiated Doshas.

Drugs :

In this type of Nasya, oil prepared by Shirovirechana Dravya like Pippali,

Vidanga, Shigru etc. are selected29.

Dose :

Table No. 3. It can be given in following dosage schedule according to Sushruta30.

1 Uttama 8 drops 2 Madhyama 6 drops 3 Hina 4 drops

Indications :

It can be used in the following conditions; Kaphapurna Talu and Shira, Aruchi,

Shirogaurava, Shula, Pinasa, Ardhavabhedaka, Krimi, Pratishyaya, Apasmara,

Gandhagyananasha and Urdhvajatrugata Kapharogas31 and Urdhvajatrugata Shopha, Praseka,

Arbuda and Kotha.


Nasya karma

18

In healthy persons Navana Nasya should be given according to the following

seasonal schedule32.

Table No. 4 Indications of Nasya according to season

Sl.No Season Nasya to be given at

1 Shita Kala Noon

2 Sharada and Vasanta Morning

3 Grishma Rutu Evening

4 Varsha Rutu Only when sun is visible

Time Schedule :

Table No.5. Navana Nasya should be administered according to the following time

schedule33.

Sl.No Roga Nasya to be given at

1 In Kaphaja Roga Fore noon

2 In Pittaja Roga Noon

3 In Vataja Roga After Noon

Avapida Nasya

This Nasya can be utilized for both Shodhana and Shamana purpose depending

upon the drug utilized.

Definition:

In Avapida Nasya, juice is expressed from paste or kalka of a drug. The word

Avapida means it is expressed juice of leaves or paste (kalka) of required medicine34.


Nasya karma

19

Method :

The paste (kalka) of required medicine is placed in a white and clean cloth and

thereafter it is squeezed to obtain the required quantity of juice, directly in the nostrils of

the patients. The administration of the drug in this way is known as Avapida nasya35.

This type of nasya may also be given with kalka (paste) etc.

It may also be given by dipping the swab (pichu) into the Kwatha (decoction) or

Sheeta (cold infusion) or Swarasa (juice) of the required drug. Though Acharya Sushruta

has categorized this under Shirovirechana, Avapida has also been used for Stambhana

purpose in treatment of Raktapitta where Sharkara and Ikshu rasa are utilized for the

same36.

Charaka has described two types of Avapida Nasya.

1) Stambhana Nasya : For this type ikshu rasa, milk etc. are used.

2) Shodhana Nasya : For this type Saindhava, Pippali etc. are used.

According to Chakrapani, Avapida nasya is of three types .

1) Shodhana

2) Stambhana

3) Shamana

Videha has mentioned two types of Avapida Nasya.

1) Sangya prabodhana : It is one type of shodhana nasya.

2) Stambhana : It is one type of shamana nasya.


Nasya karma

20

Table No.6. Dose of Shirovirechana, Avapida Nasya should be given as follows:

1 Hina Matra 4 drops

2 Madhyama Matra 6 drops

3 Uttama Matra 8 drops

Indications :

Table No.7. Avapida Nasya is indicated in the following conditions37.

Manasaroga Apasmara Shirovedana

Apatantraka Moha Mada

Murchha Sanyasa Bhaya

Krodha Bhiru Sukumara

Krisharogi Stri Raktapitta

Vishabhighata Chitta vyakulavastha

Sharangdhara recommends the Avapida Nasya for the patients suffering from Galaroga,

Vishamajwara Manovikara and Krimi38.

DHMAPANA NASYA

It is a specific Shodhana Nasya.

Synonym : Pradhmana Nasya

Definition : This type of nasya is instilled with Churna specifically for Shirovirechana.

This nasya is mentioned as Dhmapana in Charaka Samhita and as Pradhamana in

Sushruta Samhita.


Nasya karma

21

Instrument : In this type, fine powder of drug is administered through nasal passage. For

this purpose specific Nadi yantra, A tube like instrument with length of 6 angulas and

with open ends is utilized.

Method : Fine powder of required drug is kept at one end and air is blown from the other

end, so that the medicine gets puffed into the nostrils. Videha has advocated a different

procedure in this context according to him, fine powder is kept in a pottali of thin cloth

and then patient is asked to inhale deeply, so that the subtle particles of medicine enter

into nostrils.

Dose: According to Videha,

Three Muchuti (3 pinches) for method with Shadangula nadi.

Two tolas i.e. 20 gms for pottali method.

Drugs specifically mentioned for Pradhmana nasya.

Rock salt, garlic, guggulu, maricha, vidanga etc.

Here we observe that the drugs used in Pradhmana nasya are Tikshna (irritative)

and it would be safe to remain cautious while executing this Nasya.

Indications: According to Charaka, its indications are as under –

a) Shiroroga b) Nasaroga c) Akshiroga

DHUMA NASYA

Inhalation of medicated Dhuma by nasal route and elimination of dosha by oral

route is called Dhuma Nasya. Acharya Sushruta has remained aloof from description of

this Nasya.


Nasya karma

22

Types and Instrument: Acharya Charaka has mentioned special Dhuma Nadi for

Dhuma Nasya. The length of the Nadi depends upon the type of the Dhuma Nasya,

details of which are as under:

Table No.8 Showing the length of dhuma yantra nadi39

Sl.No Type of Dhuma Nasya Length of Nadi

1 Prayogika 36 angula

2 Vairechanika 24 angula

3 Snaihika 32 angula

Breadth of the nadi should be as per measurement of ones own angula.

Dose:

Two puffs are to be taken for Prayogika Dhuma.

3 to 4 puffs are to be taken for Vairechanika Dhuma.

A single puff is advised for snaihika Dhuma.

Table No.9. Drugs used fo Dhuma nasya:

1 Prayogika Dhuma Priyangu, Ushira, etc.

2 Vairechanika Dhuma Aparajita, Apamarga etc

3 Snaihika Dhuma Vasa, Ghrita etc

Indication of Dhuma Nasya40:

It is indicated for treatment of Shiroroga, Nasaroga and Akshiroga.


Nasya karma

23

MARSHA – PRATIMARSHA NASYA

The methods shared by both these types are common but the variation occurs in

context of dose. In Pratimarsha Nasya 1 – 2 drops are administered while in Marsha the

dose is of 6 to 10 drops.

Pratimarsha Nasya : Following method is employed for Pratimarsha Nasya. A

finger is dipped in the appropriate sneha up to 2 phalanges and then oil is allowed

to drop from it in both nostrils. Patient is advised to expel out the sneha, which

comes in oral cavity.

Dose – 2 drops, morning as well as in evening hours41.

The sneha should be in such an amount that it reaches from nose to gullet but

should not be enough to produce secretions in gullet

Indications42 :

♦ Pratimarsha can be given in

♦ Any age

♦ Any season

♦ Even in not suitable time and season i.e. in Varsha and Durdina

♦ Bala - Vriddha

♦ Bhiru - Sukumara

♦ Weak patients - Kshtakshama

♦ Trishna Pidita - Mukhashosha

♦ Valita and Palita

Contraindications

It is contraindicated in

♦ Dushta Pratishyaya - Krimija Shiroroga

♦ Badhirya (deafness) - Bahudosha

Madhyapi (drunkers –habitual) ♦

♦ Utklishta Doshas.


Nasya karma

24

It is contraindicated in such persons because the Sneha Matra is quite insufficient to

eliminate Doshas or Kriminasha and already aggravated Doshas may get vitiated

further43. Sushruta and Sharangadhara have described 14 suitable times for Pratimarsha

Nasya, while Vagbhatta has mentioned fifteen Kala.

Table No.10. Various Timings for Pratimarsha Nasya

No Time for Pratimarsha Nasya Su. As. H. Sha.

1 After leaving the bed in morning + + +

2 After cleaning the teeth (with Dantadhavana) + + +

3 Before going outside + - +

4 After exercise + + +

5 After sexual intercourse + + +

6 After walking + + +

7 After urination + + +

8 After passing Apanavayu + - -

9 After Kavala + + +

10 After Anjana + + +

11 After meal + + +

12 After sneezing + - -

13 After sleeping in the noon + + +

14 In the evening + + +

15 After vomiting - + +

16 After Shirobhyanga - + -

17 After defaecation - + +

18 After laughing - + -

Pratimarsha in Nasya is a very innocent procedure, it never produces any

complication and by its virtue checks any disease process44.


Nasya karma

25

Marsha Nasya

The method of administration of Marsha Nasya resembles that of Pratimarsha but

as said earlier the dose varies.

Dose – In Marsha Nasya, 6 to 10 drops of Sneha are administered.

Drugs – Though all Sneha dravya like oil, ghee, etc. can be utilized but use of oil is

advisable because Shira is the place of Kapha and oil is inherently opposite to Kapha in

properties.

Marsha Nasya is quickly effective and more beneficial than its counterpart i.e.

pratimarsha45.

CLASSIFICATION OF NASYA ACCORDING TO KARMA

This type of classification is given in Charaka Samhita as well as Ashtanga

Hridaya46ab.

Chart No.7 Classification According to Karma (Pharmacological Action)

Rechana Brimhana Shaman

Sangyaprabodhana (Shodhana)

Krimighna Stambhana Karshana

Raktastambhan Doshastambhan

The types Rechana, Tarpana and Shamana are described by Acharya Charaka and

Vagbhatta. Sushruta has not described the Shamana Nasya. He has given only two types

viz. Shirovirechana and Snehana.


Nasya karma

26

Kashyapa has mentioned Brimhana and Karshana types of Nasya karma i.e.

Sangya Prabodhana and Stambhana, according to their pharmacological action.

All these types can be included into the classification of Charaka, as in previous

pages. Details of each type of Nasya according to the Karma, is as under.

a) RECHANA NASYA

The Nasya, which eliminates vitiated Doshas of Shira through the nasal route is

also called Rechana Nasya47. It is also termed as Karshana Nasya.

Drugs : Apamarga, Pippali, Maricha etc. are drugs of choice that can be used for

Rechana Nasya. Kwatha, Swarasa or Tikshna sneha of above drugs may also be utilized

for the same.

Indications :

Stambha, Supti, Gaurava, Shiroroga etc.

According to Sushruta and Vagbhatta, it is used in Shleshma abhivypta like

Talukantaka, Shirokrimi, Arochaka, Pinasa, Pratishyaya48. Urdhvajatrugata Shopha,

Praseka, Vairasya, Arbuda, Dadru and Kotha49.

If Rechana Nasya is to be given in patients of weak will power then Sneha

preparation of Rechana dravya is applied.

b) TARPANA NASYA

Tarpana is that type of Nasya, which is specially indicated in a Dhatukshaya

(degeneration). Tarpana Nasya resembles Snehana Nasya described by Sushruta and

Sharangadhara and Brimhana Nasya mentioned by Acharya Vagbhatta in its properties

and actions.


Nasya karma

27

Drugs :

Drugs of Madhura skandha and Sneha prepared with Vata-Pittahara drugs are

used for above type50. Exudation of certain trees, meat soups and blood may also be

administered.

Indications :

Vatika Shiroroga, Dantapata, Keshapata, Darunaka and other Vata-Pittaja roga.

Sushruta advises Sneha Nasya for increasing general strength and to improve the vision

power and its acquity. It is also used for curing the Shirah kampa and Ardita51.

c) SHAMANA NASYA

It is described by Charaka as well as Vagbhatta and Pratimarsha and Stambhana

Nasya can be co-related with it.

Definition :

The type of Nasya which is used for alleviation of Dosha of Shira is called

Shamana Nasya.

Drugs :

Usually drugs beneficial for particular diseases are chosen for this type and the

carrier is a Sneha dravya.

Indication :

It is indicated to check the bleeding occurring in the course of Raktapitta.

It is also indicated in Vali, Palita, Khalitya, Darunaka, Raktaraji, Vyanga and

Nilika.

It can also be used to improve the power of eyes, ears and nose.


Nasya karma

28

INDICATIONS OF NASYA

Nasya therapy may be given in all diseases except in the conditions mentioned

earlier. The specific indications of Tarpana Nasya, Shodhana Nasya, Shamana Nasya,

Shirovirechana, Navana, Avapida, Dhmapana and Dhuma Nasya etc. have already been

discussed in the classification of Nasya, but Charaka has described the following general

indications, where Nasya therapy should be used.

Shirostambha Gadgadatva

Ardhavabhedaka Vaggraha

Shirahshula Grivaroga

Akshishula Swarabheda

Shukra Roga-Netragata Galashundika

Raji Galashaluka

Timira Galaganda

Vartmaroga Upajihvika

Pinasa Manyastambha

Nasa Shula Ardita

Danta Stambha Apatantraka

Danta Shula Apatanaka

Danta Harsha Karnashula

Danta Chala Arbuda

Hanugraha Skandharoga

Mukharoga Ansashula


Nasya karma

29

According to Ashtanga Samgraha if the Nasya is to be given as a part of

performing the complete Panchakarma then, it should be given after Basti karma.

CONTRAINDICATION OF NASYA

In our classics - Brihattrayi some special conditions have been mentioned where

Nasya should not be administered, otherwise various complications may occur. In

general, in all patients Nasya should not be administered on Durdina (Rainy day) or in

Anrutu (Viparita Kala).

Table No.11. Contra Indications of Nasya mentioned in Brihattrayi have been

tabulated below :

Sr. Anasyarha Charaka Sushruta Vagbhatta

1 Bhuktabhakta + + +

2 Ajirni + + -

3 Pitta Sneha + + +

4 Pitta Mad + + +

5 Pitta Toya + + +

6 Snehadi Patukamah + - +

7 Snatah Shirah + - +

8 Snatukamah + + +

9 Kshudharta + - +

10 Shramarta + + -

11 Matta + - -

12 Murcchita + - -

13 Shastradandahrita + - -


Nasya karma

30

14 Vyavayaklanta + - -

15 Vyayamaklanta + +(Shranta) -

16 Panaklanta + - -

17 Navajwara Pidita + - -

18 Shokabhitapta + - -

19 Virikta + - +(Shuddha)

20 Anuvasita + +(Datta Basti) +(Datta Basti)

21 Garbhini + + +

22 Navapratishyayarta + - -

23 Apatarpita - + +(Shuddha)

24 Pittadravah - + +

25 Trishnarta + + -

26 Gararta - + +

27 Kruddha - + -

28 Bala - + -

29 Vriddha - + -

30 Vegavarodhitah - + + (Vegarta)

31 Raktasravita - - +

32 Sutika - - +

33 Shvasapidita - - +

34 Kasapidita - - +


Nasya karma

31

SUITABLE TIME FOR GIVING NASYA

According to Charaka generally Nasya should be given in Pravrita, Sharada and

Vasant Rutu. However in emergency it can be given in any season by providing artificial

conditions of the above mentioned seasons, for example in summer, Nasya can be given

in cold places and in cold season, it can be given in hot places.

Table No. 12. Time schedule in different seasons should be as below52.

SL.No Rutu Nasya to be given at

1 Grishma Rutu Morning

2 Shita Rutu Noon

3 Varsha Rutu When day is clear

4 Sharada + Vasanta Morning

5 Shishira + Hemanta Noon

6 Grishma + Varsha Evening

According to Sushruta in normal condition Nasya should be given on empty

stomach.

Table No. 13. Time schedule in Doshaja Vikara should be as below53.

SL.No Doshaja Vikara Nasya to be given at

1 Kaphaja Vikara Morning

2 Pittaja Vikara Noon

3 Vataja Vikara Evening


Nasya karma

32

Vagbhatta has prescribed same timings as Sushruta has mentioned. According to

Doshaja Vikara he has suggested some more important points.

Nasya should be given daily in morning and evening in Vataja Shiroroga, Hikka,

Apatanaka, Manyastambha and Swarabhramsha.

Sharangadhara has described same time schedule for different seasons as Sushruta

has mentioned. He further states that – Nasya can be given in night, if the patient is

suffering from Lalasrava, Supti, Pralapa, Putimukha, Ardita, Karnanadi, Trishna,

Shiroroga and such conditions like excessive vitiated Doshas54.

TABLE No. 14. COURSE OF NASYA KARMA

No. Name of Acharaya Days

1 Sushruta 1,2,7,21

2 Bhoja 9

3 Vagbhatta 3,5,7,8

Vagbhatta

Nasya Karma may be given for seven consecutive days. In conditions like Vata

Dosha in head, hiccough, loss of voice, Manyasthamba, Apatanaka etc. it may be done

twice a day (in morning and evening)55.

Nasya should be given for 3 days, 5 days, 7 days and 8 days or till the patient

shows the symptoms of Samyaka Nasya as stated in Ashtanga Samgraha56.

Bhoja

Bhoja says that if Nasya is given continuously beyond nine days then it becomes

Satmya to patients and if given further, it neither benefits nor harms the patients.


Nasya karma

33

Sushruta

According to Sushruta, Nasya may be given repeatedly at the interval of 1, 2, 7 or

21 days depending upon the condition of the patient and the disease he suffer57.

Charaka

Charaka has not mentioned specific duration of the Nasya therapy, but instead

suggested to give it according to the severity of disease.

DOSE OF NASYA

The dose of Nasya drug depends upon the drug utilized for it and the variety of

the therapy. Charaka has not prescribed the dose of the Nasya. Sushruta and Vagbhatta

have mentioned the dose in form of Bindu (drops), here one Bindu means the drop which

smears after dipping the two phalanges of Pradeshini (index) finger in oil58.

Table. No.15. Showing The Dosage of Nasya Karma

Drops in each Nostril

No.

Type of Nasya Hrasva

Matra

Madhyama

Matra

Uttam

Matra

1 Shamana Nasya 8 16 32

2 Shodhana Nasya 4 6 8

3 Marsha Nasya 6 8 10

4 Avapida Nasya (Kalka Nasya) 4 6 8

5. Pratimarsha Nasya 2 2 2

Dose According to Videha :

The common dose for Pradhamana Nasya is 3 Muchuti (here one Muchuti = the

quantity of Churna which may come in between index finger and thumb = 2.4 Ratti.)


Nasya karma

34

Dose According to Sharangadhara59 :

Sharangadhara has described the following dosage schedule for Nasya Karma

depending upon the variety of material used.

Tikshnaushadhi Churna - 1 Shana (4 Masha)/(24 Ratti)

Hingu – 1 Yava (½ Ratti)

Saindhava – 1 Masha (6 Ratti)

Dugdha – 8 Shana (64 Drops)

Jala (Aushadha Siddha) – 3 Karsha (3 Tola)

Madhura Dravya – 1 Karsha (1 Tola)

If the Nasya is given in less quantity than the prescribed dose then it does not

eliminate the Doshas completely and cause heaviness, loss of appetite, cough, salivation,

coryza, vomiting and disorders of the throat etc. If the Snehana Nasya is administered in

the excessive dose it may produce the symptoms of Atiyoga

Nasyavidhi

The procedure of Nasya karma may be classified under following headings :

Purva Karma (Pre-measures)

Pradhana Karma (Chief measure)

Pashchata Karma (Post-measures)

Purva Karma (Pre-measure) : It is advisable that all materials, drugs and

equipments like napkin, utensils necessary for Nasya karma are collected in sufficient

quantity prior to Nasya karma.


Nasya karma

35

Patient should be prepared for Nasya karma. It can be described in detail as under.

Special room for Nasya should be prepared which should be free from atmospheric

effects like direct blow of air or dust and it should be lighted properly60.

Nasya Asana : It should be placed in Nasya room. It consists of -

A chair for sitting purpose

A cot for lying purpose

Nasya Aushadhi : Drug required for Nasya karma in the form of Kalka, Churna,

Kwatha, Kshira, Udaka, Sneha, Asava etc. should be collected in sufficient quantity.

Drug for counter acting any complications during or after the nasya should also be

kept ready.

Table No. 16. Nasya Yantra : It should be collected according to the types of Nasya

such as :

A dropper or Pichu For Snehana, Avapida, Marsha and Pratimarsha Nasya.

Shadangula Nadi For Pradhmana Nasya Dhuma Yantra For Dhuma Nasya

Besides it is also necessary that a stove, bowl, napkins, spitting pits and an

efficient assistant are kept handy.

Selection of The Patient : The patient should be selected according to the indications

and contra-indications of Nasya described in classics.

Preparation of The Patient : To prepare the patient for the Nasya karma following

matter should be considered according to Acharya Sushruta.

Patient should have passed his natural urges like urine and stool. He should have

completed his routine activities. Light breakfast prior (1 hour) to Nasya karma is advised.


Nasya karma

36

After preparation of patient by above said regimens, snehana and swedana should

be done. Here, Snehana means, Mridu Abhyanga. It should be done on scalp, forehead

and neck for 3 to 5 minutes by medicated oil like Bala taila61 etc.

After Abhyanga, Mridu Swedana should be done on Shira, Mukha, Nasa, Manya,

Griva and Kantha. Though according to Ayurvedic texts, Swedana should not be done on

the head, but for the purpose of elimination and liquification of dosha Mridu Swedana

can be done as Purva karma of Nasya.

Pradhana Karma (Chief measure) : The procedure to be adopted for the Nasya karma

is described here as per the statements of Charaka, Vagbhata and susrutha62abc.

Posture of The Patient :

Patient should lye down in supine position on Nasya table. The head of the patient

should be lowered (Pravilambita). The position of head should not be excessively

extended. After covering of eyes with a clean cloth, the tip of patients nose should be

drawn upward by the left thumb of the Vaidya. At the same time with the right hand

Vaidya should instill lukewarm medicine in both the nostrils, alternately, with the help of

proper instrument like pichu, dropper, shadangula nadi etc. according the type of Nasya.

The drug should be proper in dose and temperature.

The patients should remain relaxed at the time of administration of nasya and he

should avoid speech, anger, sneezing, laughing and shaking his head65.

Pashchata Karma (Post-measure) : According to Acharya Charaka66 Acharya

Sushruta67 and Acharya Vagbhatta following regimen should be followed after

administration of Nasya. Patient in lying position is asked to count up to 100 matra i.e.

approximately 2 minutes. After administration of Nasya feet, shoulders, palms and ears


Nasya karma

37

should be massaged. Again mild fomentation should be done on forehead, cheeks and

neck. For pacifying Vata dosha, Rasna churna is rubbed on head.

The patient is asked to expel out the drug which comes in oropharynx. Care

should be taken that no portion of medicated oil is left behind.

Medicated Dhumpana and Gandusha are advocated to expel out the residue

mucous lodged in Kantha. Patient should be advised to stay in a windless place. A light

meal and lukewarm water are advised. One should avoid dust, smoke, sunshine, hot bath,

anger, riding, excessive intake fat and liquid diet68.

Acharya Charaka further says that the patient should avoid day sleep and should

not use cold water for any purpose like pana, snana, etc.

SAMYAK YOGA, AYOGA AND ATIYOGA OF NASYA KARMA

After Nasya karma the symptoms of its Samyaka yoga, Ayoga and Atiyoga

should be observed, which are being described here as under.

Samyak Yoga :

The symptoms of adequate, Nasya according to Charaka are Urah-shiro-laghava

(Feeling of lightness in chest and head). Indriyavishuddhi (sensorial proficiency) and

Srotovishuddhi (cleansing of channels). In addition, Sushruta has described

Sukhaswapna-prabodhana (good sleep and awakening), Chitta-Indriya-prasannata

(mental and sensorial happiness) and Vikaropashama (Improvement). Besides these

proper respiration and sneezing have been described by Vagbhatta as general symptoms

of Samyaka Yoga of Nasya Karma.


Nasya karma

38

Table.No.17. Showing Samyaka Yoga Lakshana

Symptoms Ch. Su. As. H. Sha. B. P. Ka.

Urah Laghuta + - - - + -

Shiro Laghuta + + - - - -

Netra Laghuta - + + - +

Laghuta - - - + -

Srotovishuddhi + + - + + +

Swaravishuddhi - + - - -

Vaktravishuddhi - + - - -

Indriyaachchta-prasada + + - + + +

Netrateja Vriddhi - + - - +

Chitta Prasada - + - + + +

Vikaropashama - + - + + -

Sukha Svapna Prabodha - + + - - -

Sukhachchvasa - + - - - -

Arati - - - - - -

Medha - - - - - -

Bala - - - - - -

Ayoga :

If Nasya is not given in proper way or the dose is less, features of inadequate

Nasya arise which are Shirogaurava (heaviness in head), Galopalepa (throat coated with

mucus) and Nishthivana (excessive spitting69). According to Sushruta, Kandu (Itching),

Upadeha (feeling of wetness), Guruta (heaviness), Srotasam Kapha Srava (excess mucus

secretion in channels) are the symptoms of Hina Shuddhi70. Vitiation of Vata, dryness in

Indriya, no relief in the symptoms of the disease71, dryness in mouth and nose are other

symptoms of Ayoga of Nasya karma.


Nasya karma

39

Table No. 18. Ayoga Lakshana72

Sl.No Symptoms Ch. Su. As. H. Sha. B.P. Ka.

1 Shirogaurava and Dehagaurava + - - + + +

2 Galopalepa + - - - - -

3 Nishthivana + - - - - -

4 Kandu - + + + + -

5 Kaphapraseka - - - - - -

6 Upadeha + - + + - -

7 Rukshata + - - + + +

8 Vata Vaigunya + - - - - -

9 Srotoriktata - - - - + -

10 Srotasamkaphasrava + - - + + +

11 Nasashosha - + - - - -

12 Asyashosha - + - - - -

13 Akshistabdhata - + - - - -

14 Shiroshunyata - + - - - -

15 Vyadhi Vridhdhi - - - - - +

Atiyoga :

According to Charaka, the general features of excessive Nasya are, feeling of

Arati (uneasiness) and Toda (pricking like pain in the head, eyes, temporal region and

ears)73. Kapha Srava (Salivation), Shirahshula (headache) and Indriya Vibhrama

(confusion) are the symptoms of Atiyoga of Nasya74. Mastulungagama, Vatavriddhi,

Indriyavibhrama and Shiroshunyata (emptiness of head) are also the symptoms of Atiyoga of

Shirovirechana.


Nasya karma

40

Table No. 19. Atiyoga Lakshana

Symptoms Ch. Su. As. H. Sha. B.P. Ka. Shirogaurava - + + + + - Shiroshunyata - + - + + - Shirovedana + - - - - + Netra Vedana + - - - - - Shankhavedana + - - - - - Suchitodavata Pida + - - - - - Indriya Vibhrama - + - + + + Mastulungagama - + - - - - Snehapurna Srotasa - - - - + - Karna Talu Upadeha - - - - - - Vata Vriddhi + - - - - + Kandu - + - - - - Praseka - + + + - - Pinasa - + - - - - Aruchi - - + - - - Deha Daurbalya - - - - - + Unmada - - - - - - Pitta Vriddhi - - - - - - Hridaya Shula - - - - - - Suryavarta Roga - - - - - - Atripti - - - - - -

Vyapada :

Vyapada (complication) after administration of nasya occurs in following conditions.

♦ If patient breaches the protocol to be followed after Nasya karma.

♦ On administration of Nasya in any contra-indicated condition.

♦ Due to technical failure by any means.

The complications occur through following two modes.

Doshotklesha : This should be managed by Shodhana and Shamana chikitsa.

Doshakshaya : This should be managed by Brimhana chikitsa75.


Nasya karma

41

Details about the complication along with the reasoning for their occurrence and

treatment are as under :

If nasya is given in contraindicated conditions than many Vyapada can occur such as :

When Nasya is administered to the patient just after lunch or who is suffering

from indigestion than diseases like Kasa, Shvasa, Chhardi, Pratishyaya etc. may occur

due to obstruction of channels situated in upper part of body.

If Nasya is given in season in which it is contra-indicated for e.g. cloudy

atmosphere, then there is possibility of occurrence of Kapha roga like asthma.

Treatment : In above-mentioned conditions treatment should be done with Kapha

Nashaka Upchara like use of Ushna, Tikshna Aushadha and Kapha Nashaka karma.

If Nasya is given in Krisha, Kshina (emaciated), Virikta (patient who had taken

virechana} Aatura (anxious), Garbhini (pregnant lady), Vyayam klant (exhausted with

exercise) and a thirsty person then vitiation of Vata dosha takes place which may produce

vata-vikara.

In this condition, Vatanashaka treatment like snehana, swedana, brimhana should

be specially done, pregnant lady should be treated with ghrita and milk76.

If Nasya is administered in a madya pitta, person having fever and in

shokabhitapta then timir roga may occur.

Treatment : Ruksha, Sheeta, Lepa and Putpaka should be applied.


Nasya karma

42

Vyapada Due To Technical Failure

This can occur in following conditions -

If the drug used for Nasya is very hot or cold. The dose is not proper i.e. very less

or in excess quantity. If the posture is not proper i.e. patient has lowered his head more

during Nasya. In such conditions complications like Trishna and Udgara occur.

Treatment should be done according to the disease. If the patient faints at the time of

Nasya he should be treated with sprinkling of water on Lalata and Mukha77.

BENEFITS OF NASYA

Patient who regularly observes Nasya Karma does not become victim of diseases

of eyes, ears and nose. His hair and beard does not turn gray. His hair doesn’t falls but

instead grows fast. Diseases like common cold, migraine, headache, facial paralysis, etc.

can be alleviated. The joints, sinus, tendons and bones of his cranium acquires great

strength. His face becomes cheerful and plump and his voice becomes mallow, firm and

stentorian. Strength of all sense organs increases greatly. There will be no sudden

invasion of disease in the upper parts (Urdhvajatrugata) of the body. He experiences the

symptoms of old age later.

Disease of the supra clavicular region are cured in the person who practices

Nasya. He gets clarity of senses, good smell of mouth and the strength of jaw, teeth,

arms, chest, etc. He never suffers from the premature appearance of wrinkles, premature

hair falling and Vyanga.


Nasya karma

43

Mode of action of Nasya karma

In Ayurvedic classics, the mode of action of Nasya karma is explained indirectly.

According to Charaka Samhita, the drug administered through the nose enters in the

Uttamanga and eliminates the morbid doshas residing there.

According to Vrudda Vagbhata :

Drug administered through nose -the doorway to sheera

Reaches the Shringataka marma of Head (Sheera), which is a sira marma and formed by

the siras of nose, eyes, kantha and shrotra

The drug spreads by the same route

Scratches the morbid Doshas of Urdhwajatru and extracts them from the Uttamanga78

Indu, the commentator of Ashtanga Sangraha, opined that Shringataka is the inner

side of middle part of head i.e. “Shiraso Antar Madhyam”.

In this context Sushruta has clarified that Shringataka marma is a Siramarma

formed by the union of Siras (blood vessels) supplying to nose, ear, eye and tongue. Thus

we can say that drug administered through Nasya may enter the above sira and purifies

them79. Under the complications of Nasya karma, Sushruta80 has mentioned that

excessive eliminative errhine may cause Mastulunga Strava (flow of cerebrospinal fluid

out to the nose). which suggest the direct relation of Nasal pathway to brain.

All ancient Acharyas have said considered Nasa as the gate way of Sheera. It does

not mean that any channel directly connects brain and nose, but it may be suggestive of

any connection through blood vessels, lymphatics and nerve.


Historical review of sweda karma

44

HISTORICAL BACKGROUND OF SWEDA KARMA

It is customary, on the part of researchers belonging to various fields of

knowledge, to search the Vedas, as they are the prime sources of ancient wisdom. Such a

search of Vedas for references regarding Panchakarmas, Swedana in particular was not

fruitful.

The works during and after the samhitakala provide ample description on

Panchakarmas and their Poorvakarmas i.e. Snehana and Swedana. Among the

samhitagranthas, Charaka samhita (1000B.C.)81 was the first to describe Swedakarma

under the Shadupakramas. In this text, one can find definition, classification, indications,

contra-indications and benefits of Swedana. Bhela82, considered contemporary to

Charaka, had also described Swedana in detail in the Sweda adhyaya of sutrasthana.

Kashyapa samhita83, written by Vriddha Jeevaka (600B.C.) did mention Swedakarma and

descriptions are found with minor differences from Charaka samhita. The next book that

provides equal details is Sushruta samhita84 written in 2nd century A.D. Ashtanga

samgraha85 and Ashtanga hridaya86 had also allotted separate chapters for Sweda

karma87abcdef.

Various literary works belonging to the Classical Age of Indian Literature (320

AD – 740 AD88) had also mentioned the usefulness of Swedakarma. Later textbooks on

Ayurveda such as Sharangadhara samhita89 and Chakradatta90 had described Swedana

karma under a separate chapter, while texts such as Bhavaprakasha91,

Bhaishajyaratnavali92 and Yogaratnakara93 had mentioned the utility of Swedakarma in

various diseases.


Historical review of sweda karma

45

Sweda94: - Sweda is a word of masculine gender. Sweda word is coined by the

combination of “Swit” dhathu and “Dhanj” pratyaya. Sweda is a shareeramala, which is

associated with body heat mechanism.


Sweda karma

46

Sweda karma

The process which relieves stambha (stiffness), gourava (heaviness), sheeta

(coldness) and which induce sweda (sweating) is known as Sweda karma95. In general,

Sweda karma represents the therapy by which a person is made to sweat. Swedana will

cure Vata, Kapha and Vatakaphaja disorders96. But, it is not recommended in disorders

due to excitement of Pitta.

Even though, swedana is poorva karma, it has its own entity as pradhana karma in

some diseases. Charaka included Sweda karma in Shadupakramas and he has treated it as

main therapy97. For samshodhana purpose, it is considered as poorva karma. In sweda

sadhya diseases it acts as main therapy.

Properties of Swedana drugs98

Generally guru, teekshna and ushna dravyas induce sweating. Drugs with the sara,

snigdha, rooksha, sukshma, drava and sthira gunas are also utilized in Sweda karma.

Table No. 20. Showing the properties, action and predominance of mahabhootas of

swedana dravyas:

Sl. Properties Main actions Mahabhuta 1 Ushna Anutsaha, moorchakrit, swedakrit and dahakrit Agni 2 Teekshna Daha-pakakara, shodhananga, sraavana Agni 3 Snigdha Snehakrit, mardavakrit, bala-varnakrit Apa and Prithwi 4 Rooksha Opposite to snigdha and stambhakara, khara Vayu and Agni 5 Sara Anulomana, prerakata and pravrittisheela Vayu and Agni 6 Sthira Chirakaritha, sthairyakara and stambhakara Prithwi 7 Sookshma Sookshmachidrapraveshayogyata,vivarana sheelata Akasha, Vayu and Agni 8 Guru Sada, upalepa, tarpanakrit and brimhanakrit Prithwi and Jala 9 Drava Kledana, alodana, syandanakaraka Jala


Sweda karma

47

Swedayogyas (Swedarhas99,100,101)

Table No.21. Showing the persons and diseases that are fit for swedana.

Sl. Vyadhi C.S. S.S. A.H. Sl. Vyadhi C.S. S.S. A.H.1 Pratishyaya + - + 30 Uru ruk / graha + - + 2 Kasa + - + 31 Jangha ruk / graha + - + 3 Hikka + - + 32 Kshavathu + - - 4 Swasa + - + 33 Khalli + - + 5 Alaghava + - - 34 Ayama + - + 6 Karna shoola + - - 35 Sheeta + - - 7 Manyasthamba + - - 36 Vepathu + - + 8 Shira shoola + - - 37 Vatakantaka + - + 9 Swara bheda + - + 38 Sankocha + - +

10 Gala graha + - - 39 Ayamashoola + - + 11 Ardita + - + 40 Stambha + - + 12 Ekanga roga + - + 41 Gourava + - + 13 Pakshaghata + - + 42 Supti + - + 14 Ardita + - + 43 Nasyarha + + + 15 Vinamaka + - + 44 Bastyarha + + + 16 Koshtanaha + - + 45 Shodhaneeya + + + 17 Vibandha + - + 46 Aahritashalya - + - 18 Mutraghata + - - 47 Anupadrava

moodhagarbha - + -

19 Vijrimbhaka + - + 48 Samyak prajata - + - 20 Parshwagraha + - + 49 Bhagandara - + - 21 Prishtagraha + - + 50 Arsha - + - 22 Kateegraha + - + 51 Ashmari - + - 23 Kukshigraha + - + 52 Shleshma roga - - + 24 Gridhrasi + - + 53 Amaroga - - + 25 Mutrakrichra + - + 54 Hanugraha - - + 26 Vriddhi + - + 55 Arbuda - - + 27. Angamarda + - + 56 Granthi - - + 28 Pada ruk / graha + - + 57 Shukraghata - - + 29 Janu ruk / graha + - + 58 Adhyamaruta

(Urustambha) - - +

Sushrutha had specified that those who are fit for Nasya, Basthi and Shodhana are

Poorvam Swedyas ; Ahritashalya, Moodhagarbha and Samyak prajata are Paschat

Swedyas ; and Bhangandara and Arsha are Poorvam Cha Paschat cha Swedyas102.


Sweda karma

48

We can conclude that, in general, there are three categories of diseases wherein

swedana is indicated – a) Vatapradhana rogas, b) Kaphapradhana rogas and c)

Shodhaneeya and Shadyakarmayogyas.

Sweda ayogyas (Sweda anarhas)103,104,105

Table No. 22. Showing the persons and diseases those are unfit for Swedakarma.

Sl. Vyadhi C.S. S.S. A.H. Sl. Vyadhi C.S. S.S. A.H.1 Kashayanitya + - - 24 Adhyaroga

(Vataraktha) + - +

2 Madyanitya + + - 25 Durbala + + + 3 Garbhini + + + 26 Ativisushka + - - 4 Rakthapitha + + - 27 Ksheenaoja + - - 5 Pithakopa + - + 28 Timira + - + 6 Atisara + + - 29 Pandu - + + 7 Rooksha + - - 30 Kshaya - + + 8 Madhumeha + + + 31 Kshama - + + 9 Vidagdhabradhna + - + 32 Ajeerna - + - 10 Bhrashtabhradna + - + 33 Chardi - + - 11 Visha + + - 34 Moorcha - - + 12 Madyavikara + - + 35 Stambhaneeya - - + 13 Shrantha + - - 36 Visarpa - - + 14 Nashtasamjna + - - 37 Kushta - - + 15 Sthoola + - + 38 Peeta dugdha - - + 16 Pithameha + - - 39 Peeta sneha - - + 17 Trishna + + + 40 Peeta dadhi - - + 18 Kshut + - + 41 Peeta madhu - - + 19 Krodha + - + 42 Krita virechana - - + 20 Shoka + - + 43 Glani - - + 21 Kamala + - + 44 Bhaya - - + 22 Udara + + + 45 Pushpitha - - + 23 Kshatha + - + 46 Sootha - - +

Reasons for the exemption of these diseases from swedana have been

explained by various acharyas. Sushrutha stated that in these conditions, which are

contra-indicated for swedana, if swedana is performed either the body gets destroyed, or

the diseases progress to incurable stage. He also permits the performance of swedana in


Sweda karma

49

durbala and ajeernabhaktha, if their vikaras are curable only by swedana106. Chakrapani,

commenting on the verses of Charaka, says that kashayanityas become rookshas and

atistabdha gatras; hence, the swedana if performed causes parvabheda. Also persons

suffering from rakthapitha, pithameha, kamala etc. and pittaprakriti persons are

exempted from swedana even prior to shodhana as it may cause further pittakopa.

Madhumeha persons develop shareera shaithilya and in such a condition, swedana is

contra indicated. He also adds that if the condition of the patient is Sweda eka sadhya,

then the sweda be permitted107.

Arunadatha, commenting on the verses in Ashtangahridaya, states that swedana

if done to an atisthoola person causes medovilayana resulting in shareera kshobha. For

rooksha, durbala, kshataksheena, kshama etc. The swedana may cause extreme

emaciation. A person having good appetite if undergoes swedana suffers from dehaglani.

In kamala and pandu rogas, the Swedakarma causes pitta vidradhi resulting in roga

vridhi. In garbhini, the swedana induces gabrha vyapat. For pushpitha ladies, it causes

excessive bleeding. For sootha, it causes emaciation108.

As Vagbhata109 had stated if these conditions are atyayika, then mridu sweda can

be stated, Arunadatha110 too supports this view. Hemadri111 further states that even if a

condition/disease is aswedya, the stage being atyayika (due to the inevitability of

swedana) mridu sweda can be performed.

In general, we can conclude that Swedakarma is contra-indicated in four

conditions: – (1) pitta, (2) raktha, (3) durbala avastha and (4) sweda asaha. Also it is to

be noted that swedana can be performed in mridu mode if these conditions are sweda eka

sadhya.


Sweda karma

50

Samyak swinnalakshanas112

Table No.23. Showing the lakshanas to be observed on the patient.

Sl. Lakshana C.S. S.S. A.H. 1 Seetha vyuparama + - + 2 Shoola vyuparama + - + 3 Sthambhanigraha + - - 4 Gouravanigraha + - - 5 Sanjathamardava + + + 6 Swedasrava - + - 7 Vyadhihani - + - 8 Laghutva - + - 9 Seetharthiva - + -

Among these shoola vyuparama, sthambhanigraha, gourvanigraha, laghutva,

mardava and vyadhihani are not evident immediately after swedakarma every day, but

manifest after the total course of proper swedana. Sheeta vyuparama, swedasrava and

seetharthitva are to be observed daily at the end of swedakarma daily.

Aswinnalakshanas

If the swedana performed is not sufficient or proper, then the lakshanas opposite

to the samyak swinnalakshanas occur. Dalhana adds that heaviness of the body,

ushnabhilasha and hardness of the body also occur. He has stated that mithya swinna

means both alpa swinna and mithya swinna (improper sudation) and that vyadhi vridhi

also occurs113.

Atiswinnalakshanas114,115,116.

If the swedana performed is in excess, it leads to many complications.


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51

Table No. 24. Showing the Atiswinna lakshanas on the patient.

Sl.no Lakshana C.S S.S A.H 1 Pitta prakopa + + + 2 Murcha + + + 3 Shareerasadana + - - 4 Trishna + + + 5 Daha + + - 6 Swaradourbalya + - + 7 Angadourbalya + - + 8 Sandhipeeda - + + 9 Sphototpathi - + - 10 Rakthaprakopa - + - 11 Bhranthi - + - 12 Vidaha - + - 13 Klama - + - 14 Bhrama - - + 15 Jwara - - + 16 Syava-raktha mandaladarshana - - + 17 Chardi - - +

Management of Atiswinna

Charaka117 advises the adoption of greeshma ritu charya along with consumption

of madhura-snigdha-seetha aharas and to follow snigdha-seetha upacharas. This includes

consumption of sasharkara mantha, jangala mriga-pakshimamsa, ghee, milk and

shashtikashali. Madya should be avoided. Ahara dravyas with lavana, amla, katu and

ushna properties and viharas such as vyayama should be avoided. Patient should live in

seethagriha during the day and in the room cooled by moon rays in the night.

Seethadravyas like chandana can be applied over the body. Mukthamani dharana also

can be done. Patient can also be taken to cool forests and ponds. He/She should not

indulge in intercourse118. Sushruta says that all kinds of seetha upachara should be

performed immediately119.


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52

Vagbhata had advised the adoption of stambhana chikitsa in case of atiswinna120.

Drugs, which are having the properties of laghu, manda, seetha, slakshna, rooksha,

sookshma, sura and drava and having tiktha-kashaya-madhura rasas, are stambhana

oushadhas. These are to be administered internally and externally to prevent further

complications of the patients.

Classification of Sweda

Several types of classification of Sweda are made with different points of view.

A) According to agni bheda121.

a) Sagni (Thermal) b) Niragni (Non-thermal).

B) According to guna bheda122.

a) Rooksha (Dry) b) Snigdha (Unctuous).

C) According to sthana bheda123. a) Ekanga (Local) b) Sarvanga (Total).

D) According to rogi bala and roga bala124 a) Mrudu (Gentle), b) Madhyama

(Medium) c) Mahan (Maximum).

E) According to the source of heat125,126. a) Tapa (Direct heat), b) Ushma (Steam), c)

Upanaha (Poultice) d) Drava (Warm liquid).

F) According to the method of sudation127. a) Sankara (Mixed), b) Prastara (hot bed),

c) Nadi (Steam kettle), d) Parisheka (Affusion), e) Avagaha (Bath), f) Jentaka

(Sudatorium), g) Asmaghna (Stone bed), h) Karshu (Trench), i) Kuti (Cabin), j) Bhu

(Ground bed), k) Kumbhi (Pitcher bed), l) Kupa (Pit sudation) and m) Holaka (Under

bed).

G) According to the usefulness in the Chikitsa, Samshamaneeya and

Samshodhanangabhoota128.


Table No. 25. TYPES OF SWEDA

01. Snigdha 02. Rooksha

01. Ekanga 02.Sarvanga

01. Samshamaneeya 02. Samshodhaneeya

01. Mridu 02. Madhyama 03. Mahan

01. Sagni 02. Niragni

Tapa Upanaha Ushma Drava

Pani Pradeha Pinda Parisheka

Kamsya Bandhana Samstara Avagaha

Phala Sankara Nadi

Valuka Ghanashma

Vastra Kumbhi

Ghatika Kupa

Kuti

Jentaka

01. Vyayama 02.Ushnasadana 03. Gurupravarana 04. Kshudha

05. Bahupana 06. Krodha 07. Bhaya 08. Upanaha

09. Aahava 10. Aatapa

53

Sweda karma

54

H) According to the route of application. Bahya and Abhyantara129

On the basis of applicability in children. Hasta, Pradeha, Nadi, Prastara, Sankara,

Upanaha, Avagaha and Parisheka130.

Niragni Sweda is further classified into ten types, viz., vyayama (exercise), ushna

sadana (warm rooms), guru pravarana (heavy blankets), kshudha (hunger), bahupana

(excessive drinking), bhaya (fear), krodha (anger), upanaha (plasters), ahava (war) and

atapa (sun bath)131.

Dalhana had said that jentaka, karshu, kuti, kupa and holaka are tapa swedas ;

sankara, prastara, ashmaghna, nadi, kumbhi and bhu are ushma swedas132.

Bashpasweda and Shahtikashalipindasweda belong to the Ushma type of

Swedana. Dalhana has defined Ushma sweda as “Ushma bashpaha”. He has opined that

all the techniques of ushma sweda can be collectively called as bashpa sweda133.

Nadi sweda

This is done with the steam coming from the vessel full of boiled

mamsarasa, milk, curd, dhanyamla or vataharapatrabhanga kwatha. The top of the vessel

is to be covered with kambala etc. for the prevention of excessive heat affecting the

patient134. Otherwise, the mouth of another vessel, which has a hole in its side, should

cover the top of this vessel. Sandhibandhana is done on the mukhas of the vessels. To the

hole of the upper vessel, a nadi (tube) resembling hastishunda (trunk of an elephant) of

one or ½ vyama (hand) length, having three folds and made of trina, kasha etc. is

connected. Before performing nadi sweda, the patient should be done abhyanga and

covered with a thick blanket. This is a very good method of swedana where all the angas


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55

are done proper sudation without any difficulty135. The Bashpasweda used in this study is

a modification of this classical technique.

Sankara sweda136

The process of thermal sudation by means of a bolus containing tila, masha etc.

with or without wrapping cloth is known as sankara sweda or pinda sweda. It is of two

types viz., Snigdha andRuksha.

Sudation is done with the boluses of the seeds of tila, masha, kulatha mixed with

amla dravya, ghee, taila, mamsa, odana, payasa and krishara is called as Snigdha pinda

sweda. It is specially indicated in Vata rogas.

Sudation with the excreta of various animals like cow, ass, camel, pig etc. and

other substances such as satushayava, sand, powder, stones, dry cow dung cake, iron

powder etc. is called as ruksha pinda sweda, which is indicated in Kapha rogas.

According to Sushruta and Vagbhata, Upanaha type of sweda is considered as one

among saagni swedas. At the same time, Charaka and Vagbhata have considered this as a

niragni sweda also. Chakrapani, commenting on Charaka samhita, stated that upanaha is

of two types – Sagni and Niragni137. The sagni upanaha is nothing but sankara sweda

itself. An example for it is the Kolakulathadi yoga explained in Charaka samhita

Suthrasthana.

All the Pindaswedas are based on the principle of Sankarasweda138.

Pinda swedas

As this study is on a major technique of pinda sweda, it will be relevant to

describe in brief other techniques of pinda sweda too.


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56

Pinda sweda is a process by which the whole body or a specific part of the body is

made to perspire by the application of certain heated medicinal puddings applied

externally in the form of pinda or boluses tied up in square pieces of cloths. The

technique is a combination of snehana (oelation), mardana (massage) and swedana

(fomentation). Pinda Sweda will come under sankara sweda of Charaka and Kashyapa

and ushma sweda of Sushruta and Vagbhata.

The following pinda swedas are being practiced commonly.

1) Shashtikashalipindasweda

2) Patrapotalipindasweda

3) Choornapindasweda

4) Valukasweda

5) Tushapindasweda

6) Jambeerapindasweda

7) Mamsapindasweda

8) Kukkutandapindasweda

9) Mashapindasweda

10) Godhumapindasweda

11) Dhanyapindasweda

12) Haridradi pindasweda

1. Shashtikashalipindasweda139

Details of this process will be discussed in the methodology chapter as this study

deals specially about Shashtikashalipindasweda.


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Effects Of Shashtikashalipindasweda - The effects of this treatment, if

properly done, are many. It cures powerful Vatarogas affecting all parts of the body;

diseases due to Rakthaprakopa; diseases which are very difficult to treat and diseases

which are affecting the strength (or immunity) of the body. In addition to these,

Shashtikashalipindasweda cures all types of diseases of the nervous system, chronic

rheumatism, pain in the joints, emaciation of the limbs and diseases born of vitiated

blood. This karma makes the body strong and sturdy with well-developed musculature. It

maintains the metabolism in a healthy condition from every point of view. This treatment

is found to be efficacious in subjects suffering from blood pressure and in certain kinds of

skin diseases resulting from impurity of the blood. This may also be resorted to once a

year, by healthy persons to keep up perfect health during old age and to prevent

premature aging.

2. Patrapotalipindasweda140

Also known as “Ila kizhi” or “Pachakkizhi” (common names), this type of pinda

sweda uses cut Vataharapatras in the form of pottali. Patras of arka, eranda, shigru,

nirgundi, karanja, chincha etc. are taken in equal quantity and cut into small pieces.

Coconut scrapings and citrus fruit can also be mixed together with the patras. This

mixture should be roasted in suitable taila (e.g. Bala taila, Masha taila, Nimba taila etc.)

fit for disease. After proper frying, the mixture should be tied as two boluses in clean,

square clothes.


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These pindas are again heated in suitable taila and applied to the body in

comfortable heat. Out of the two pindas, one pinda should be in the vessel over gentle fire

while the other pinda is used for massage. Bolus should be taken by the right hand and

the intensity of heat is tested by the outer surface of the left hand before starting the

procedure. The patient should be well massaged with vatahara taila or taila suitable to

disease in prior. As soon as the bolus, which is in use losses the heat, it should be

replaced by the bolus, which is kept over the fire. Left hand of the attender should do the

light massage in the direction of the bolus.

The process has to be done without any interruption for a minimum time of 30

minutes on the first day. Application should be done by asking the patient to position in

all the seven postures. If the physician decides to perform the therapy for 7 days, the

duration should be increased by five minutes each day, thus reaching 45 minutes on the

fourth day. From there it is reduced by five minutes per day to reach the original duration

(30 minutes) on the seventh day.

If the therapy is for 14 days, the increase in the duration is the same reaching the

maximum of one hour on the seventh day. Sometimes is the duration on eighth day also

and from there, the duration is reduced. These are subject to the individual rationality of

the physician.

After the prescribed duration, the oil is wiped off the body with a dry towel.

Patient should be protected from immediate exposure to cold, sun, wind etc. and allows

to take rest for a few minutes. Then he is advised to take bath in water boiled with

vataharapatras.


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The drava in which the bolus is heated may be dhanyamla, gomutra,

vataharakashaya etc. The bolus of the contents should be changed daily or at least once in

three days. Two attendants are needed for the karma – one to perform the pinda sweda

and other to heat the bolus. Indications are prasupthi, kampa, angamarda, pakshaghata,

askhepaka, gridhrasi, sandhigatavata, kateeshoola etc.

3. Choornapindasweda141

This is performed with boluses of medicinal powders and is also known as

‘Podikkizhi’ (common name). Powders of rasa, ashwagandha, sarala, shunti, vacha,

shigru, devadaru, sarshapa, kola, kulatha, masha, godhuma, mudga, tila etc has to be

taken and added saindhava lavana. Each has to be taken 10 gms and 30 gms of coconut

scrapings and 2 or 3 pieces of citrus fruits can also be added. These powders and other

items well mixed are to be fried in suitable oils and made into two boluses.

The procedure and duration are same as the patrapottali sweda. This procedure is

the snigdha variety of choorna pinda sweda. The rooksha variety of choorna pinda sweda

is also common. Powders of kulatha, tusha etc are fried in iron pan along with saindhava

lavana without oil and then made into bolus.

Snigdha choornapindasweda is indicated in Vatarogas like apabahuka, gridhrasi

etc. and rooksha choornapindasweda is indicated in saama-kaphanubandha Vatarogas like

amavata.

4.Valuka sweda142

In this the bolus is prepared of sand. This is a typical rooksha sweda indicated in

amavata, vatarakta, urustambha etc. Here, the sand can be fried in dhanyamla along with


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60

saindhava lavana. Much care should be taken in testing the heat of the bolus and only

moderate heat should be applied.

5.Tushapindasweda143

It is a process by which the bolus is prepared by the husk of the paddy. Husk of

the wheat also can be used. It is a household practice in our country in swasa and kasa.

6. Jambeerapindasweda144

Drugs used in this are jambeeraphala, saindhava lavana, and fried powders of

methika, kulatha, haridra and shatapushpi. 10 citrus fruits of big size should be cut into

the small pieces and 30 gms of haridra choorna and 5 gms of saindhava is added and fried

in suitable oil and made into bolus. It is beneficial in pakshaghata, apabahuka, sandhi

gatavata, bhagna etc.

7. Mamsapindasweda145

It is similar to Shashtikashalipindasweda. If mamsa is alone made into bolus, the

drava dravya for cooking and heating is mamsa rasa. If mamsa is used along with

shashtikashali, balamoola kwatha along with ksheera are the drava dravyas for cooking

the mamsa and shali and also for heating the bolus. Meat of goats, hen, pig, peacock etc.

are generally used.

It is mainly indicated in emaciation (Shosha) prominent conditions such as

atrophy, dystrophy, myopathy, pakshaghata, balavata etc. It arrest the premature aging,

promotes the growth, tonicity and strength of muscles.


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8. Kukkutandapindasweda146

Egg yolk of hen is used for this technique. Two lemon fruits are taken and cut into

pieces. It is mixed with three boiled egg yolks and fried in suitable oils and made into

bolus. It is beneficial in ardita, greevagraha, hanugraha, apabahuka etc.

9. Mashapindasweda147

Here, instead of Shashtikashali, masha (Phaseolus radiatus) is used and the

procedure, duration and indications are similar to Shashtikashalipindaswedakarma.

10. Godhumapindasweda

Here, instead of Shashtikashali, godhuma (wheat) is used and the procedure,

duration and indications are similar to Shashtikashalipindasweda.

11. Haridradi pindasweda148

This is specially indicated in Kshata (Trauma). Here, haridra choorna and laja

choorna are taken in more quantity and sarja choorna, jeeraka choorna and manjishta

choorna in less quantity. The white part of two boiled eggs is mixed thoroughly with

these powders and the end product is used as a bolus.

12. Dhanyapindasweda149

Fried powders of masha, mudga, tila, sarshapa, shashtikashali, kulatha, methika,

shatapushpa and eranda beeja are made into bolus. Also, these can be cooked in milk

squeezed from coconut scrapings and made into bolus and used instead of

shashtikashalipinda.


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Swedakarmas and Karmukata

Swedakarma has four major actions over the body –

(a) stambhaghnata, (b) gouravaghnata, (c) seethaghnata and (d) swedakarakata.

a. Stambhaghnata

Stambha means stiffness. This attribute is a resultant of excess seetha guna and

also influence of factors such as samanavata, sleshakakapha, ama, mamsa, vasa and

medas is contributory to the production of stambha. Samanavata is rooksha gunapradhana

and hence if vitiated does excessive shoshana of shareera there by producing contractures

and stiffness. Sleshakakapha is snigdha and pichila and hence if decreased (kshaya)

results in less lubrication of joints causing stiffness.

Swedakarma being snigdha and ushna corrects both these deranged dosha

ghatakas and relieves stiffness. Chakrapani had stated that stambha also means

obstruction or block. Therefore, swedana not only relieves stiffness, but also clears

blocking of passages (srotorodha). Srotas as a structural entity is Kaphapradhana. Ayana

or transport is the most important function of srotas. This is under the control of Vata.

There by it is evident that there is a predominant influence of Vata and Kapha over the

srotas. Vitiation of these two hampers the structural and functional aspects of the srotas.

We know that swedana has the opposite qualities to that of Vata and Kapha,

thereby producing a palliative effect on them and the srotas is becoming normal. It is

well known that unless there is a srotodushti there is no disease. Thus, it is evident that

swedana clears the srotodushti or sanga.

In other words, by contact of bearable warmth, the area in contact gets more

circulation. The lumina of the contracted body architecture get smoother and wider. This


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rendering a stiff entity smooth relieves variety of obstructions. Widening of the core and

simultaneous liquefaction of the solid or semi-solid material makes the flow easier.

Widening of the tract and fluid character of the material inside makes the obstructions

released slowly.

b. Gouravaghnata

Heaviness of the body is being relieved by Swedana. By means of swedana, the

fluids in the body are being excreted through the sweda (sweat) and hence the feeling of

lightness in the body. Swedana stimulates the nerve endings and promotes muscle

strength.

c. Seethaghnatha

Seethaghnatha has to be understood as the patient is relieved of the coldness

existing prior (the ushna guna pradhana sweda karma is performed). In fact, by the

excretion of sweat, the heat in the body is being transferred out.

d. Swedakarakata

Swedana produces perspiration. This is a mala (excretory product). In this, the

wastes of all the layers of skin, muscles, nerves, rasa, raktha, meda etc. are mixed.

Therefore, it is a mechanism of excreting the metabolic wastes in the body tissues.

Apart from these major actions, Swedana also produces the following effects.

1. Doshadraveekarana

Snehana performed prior to swedana makes the doshas mridu and

eradicates the mala sanga. The swedana penetrates to each and every channel in the body


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64

and liquefies the doshas. These liquefied doshas has to be eliminated from the body

means of shodhana karma.

2. Vata shamana

Snehapoorvayukthasweda pacifies the Vata dosha, thereby curing the

pureesha-mutra-shukra sanga. By its properties opposite to that of Vata, it pacifies the

Vata. Sweda is also one of the upakramas of Vata.

3. Gatra vinamana

Charaka says that by application of oil and heat, even dry wood can be

bent then what is the wonder about shareera. It cures harsha, ruk, ayama, shopha,

stambha and graha and produces mardava, thereby permitting normal flexible body

movements.

4. Agnideepana

As swedana is ushna guna pradhana, it does the ama pachana there by

promoting the agni in the body.

5. Twak mardava and Prasadana

Perspiration is dependent on skin, where in the hair follicles which are the

moolas of swedavaha srotas are situated. Due to sweating and excretion of wastes, the

skin becomes soft and pleasant.

6. Bhakthasradha

As the swedana promotes agni, more interest on food consumption is

resulting.


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65

7. Srotosuddhi

The mechanism of making srotosuddhi has been explained under the

action stambhaghnata.

8. Nidra-Tandra nasha

Swedana pacifies Vata. Vata is responsible for the functions of indriyas

wherein nidra and tandra are affecting. Sweda also pacifies Kapha thereby making the

body light, and providing relaxation. Thus it prevents excessive sleep and drowsiness.

9. Sandhicheshtakara

Swedana relieves stambha and graha thereby promoting the sandhicheshta.

10. Dosha shodhana

The doshas situated in the dhathus, koshta and sakha-asthi and those leena

in the srotas gets kledana by snehana and gets liquefied by the swedana and comes to the

koshta and get ready for elimination by means of shodhanakarma.


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NASYA ACCORDING TO MODERN VIEW

There is no direct pharmacological correlation between nose and brain. However

the olfactory area is the only place in the whole human body where there is direct contact

between the outer surface and Central Nervous System. It is known that blood brain

barrier is a strict security system due to which many drugs cannot reach in the brain.

However the effect of drug on the brain, administered through the nasal pathway

can be seen in followed examples.

The nose is used as a route of administration for inhalation of anaesthetic drugs.

The importance of Nasal route is indicated by the fact that Dr D. N. Rao of

AIIMS delivered antigenic peptide related to the AIDS virus by packaging them in

porous polymer microsphere and aerosolizing them in rats (The Hindu).

Ethanol suspension of Insulin sprayed through nebulizer gave excellent results in

rats without producing any allergy. Certain agents are used as decongestants in the

treatment of paranasal sinusitis. In modern medicine system, anterior pituitary hormones,

in the form of Nasal spray are being used since a long time. In the same way Vasopressin

is already in market in the form of Nasal therapy.

In some researches, it is found that Nasal administration of leutinizing hormone

and calcitonin are equally effective in maintaining blood concentration as in Intra-venous

effusions. ( Fink G. et al 1973; Pontrioli E. A. et al 1983)

The studies show that perspired scent that has been painted on upper lips has

caused synchronization of the menstrual cycle in Female volunteers by contact smelling

(Michael Russel, 1977).


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67

Nasal administration of an LRH antagonist for 3-6 months was found to be

effective in inhibiting ovulation as a contraceptive measure (Berauist et al 1979) In this

case absorption of drugs is believed through nasal and pharyngeal mucosa. Kumar Anand

(1979) has attempted contraceptive drug administration through Nasal route and opined

that the route is beneficial than systemic administration. It was also found that

concentration of the drug in C.S.F. was very high to that when administered

intravenously. An experimental study, carried out by fragrance inhalation method, to

observe the lactation inhibiting effect of Jasmine flowers, proved beneficial on rats. The

findings also showed reduction of gland activity and decrease in serum prolactin

(Abraham 1979).

Hypoglycaemic effect of Insulin and hyperglycaemic effect of Glucagon

hormones are confirmed by intra-nasal administration in normal and diabetic patients.

- Pontrioli E. A. et al. 1983 Cryptorchid boys (having undescended testis) have been

treated by intranasal GTRH (Gonadotropin Releasing Hormone) to stimulate leutinizing

hormone secretion. - Raifer J. et al 1985

It is proved by scientist of Institute of Medical Science, Delhi that the drug

administered through nose shows effective action on brain. By above-mentioned

examples it can be said that there is very close relation between brain and nose.

Thus to understand the action of Nasya drug on central nervous system it is

necessary to know the probable pathways of action of Nasya dravya. On the basis of

fractional stage of Nasya karma procedures, we can draw certain rational issues that are

as follow :


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Effect on Neuro-vascular Junction

Specific posture during Nasya karma, like the lowering of the head, fomentation

of face seems to have an impact on blood circulation of the head and face. The efferent

vasodilator nerves are spread out on the superficial surface of face. They receive

stimulation by fomentation and this may increase the blood flow to the brain i.e.

momentary hyperemia. According to Chatterjee, approximately 22% of total dilatation of

cerebral capillaries, caused by facial efferent stimulation will lead to 150% blood in flow.

– Chatterjee 1980

It is also possible that the fall of arterial pressure due to vasodilation may induce

the Cushing’s reaction.

Due to this reaction a “Slush” is created in intra-cranial space, which probably

forces more transfusion of fluid in brain tissue which may lead to make possible the drug

action in the brain.

This can be explained by the example of drug like benzyl penicillin. The drug

does not attain therapeutic level in the brain in normal conditions. But it is found to be

effective during the meningitis (the inflammatory condition of meninges). (Gillman and

Goodman 1980).

Absorption and transportation of the drug administered by nasal pathway :

Keeping the head in lowering position and retention of medicine in nasopharynx

help in providing sufficient time for local drug absorption. Any liquid soluble substance

has greater chance for passive absorption through the cell of lining membrane.

The drug absorption can also be enhanced by massage and local fomentation.

Fingl 1980


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The absorption of drug, promoted by massage and local fomentation can occur in

two ways : By systemic circulation Direct pooling into the intra-cranial region The

second way is of more interest. It can occur in two ways

a) By vascular path

b) By lymphatic path

Transportation By Vascular Path :

Pooling of the blood of nasal vein and of opthalmic vein occurs in facial vein

naturally. It is interesting that both facial and opthalmic veins have no venial valve in

between. As a result the blood may drain on either side. It means blood from facial vein

can enter in cavernous venous sinus of the brain in reverse direction. Such a pooling of

blood in the brain is more possible in head lowered position due to gravity. Thus the

absorption of drug in meninges and related intra-cranial organ is considerable point.

In the support of this hypothesis it is described in modern medicine also that the

infective thrombosis of facial vein may lead to infection of meninges easily, through this

path.– William et al. 1971 Pooling of the blood from paranasal sinuses is also possible in

the same manner.

Shringataka marma, mentioned by Acharya Vagbhatta can also be explained by

above description.

Drug Transportation By Lymphatic Path :

Through this pathway drug can reach directly into the C.S.F. Along with olfactory

nerve, the arachnoid matter sleeve is extended to sub-mucosal area of the nose.

Correlation between them is understood by the fact that dye injected to arachnoid matter

causes colouration of nasal mucosa within seconds and viceversa also.


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70

Preliminary studies reported from AIIMS Laboratory’s shows that when steroids

are administered through nasal pathway, they enter rapidly in C.S.F. Their level in C.S.F.

was found to be much higher as compared with systemic injections.

Here it is important to remind the statement of Sushruta that the excessive

administration of Virechana Nasya (eliminative errhine) may cause oozing of mastulunga

(C.S.F.) into the nose.

Thus we can say that the ancient scholars of Ayurveda had some knowledge of

lymphatic path and functional relation between nose and brain.

Importance of Post Nasya Massage :

The absorption and transportation of drug administered through nasal route is

explained in previous pages. Post Nasya massage, recommended by ancient Acharya is

as important as the massage before Nasya.

Post Nasya massage on the frontal, temporal, maxillary, mastoid and manya

region may help to subside the irritation of the somatic constriction due to heat

stimulation. It may also help in removing the slush created in these regions.

According to Sushruta, manya is a marma existing in neck on either side of

trachea150. Which likely corresponds to the carotid sinus of neck on the bifurcation of

common carotid artery. The receptors called baroreceptors are situated here and

manipulation on it may have a buffering action on cerebral arterial pressure.

– Best and Taylor, 1988

Pressure applied on the baroreceptors is also found to normalize the deranged

cerebral arterial pressure. – Hejmadi S. 1985


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71

On the basis of this fact, we can understand that procedures, postures and

conducts explained for Nasya karma have a great importance in drug absorption and

transportation.

Thus it can be stated that there is a definite effect of Nasya karma on the diseases

of nervous system, endocrine system and psychiatric disturbances.

In this way, procedure of Nasya is beneficial in various diseases and for

maintenance of healthy condition too.

How does the drugs enter into the brain can be discussed below. The absorption

of the drugs are carried out in three media. They are:

By general blood circulation, after absorption through mucous membrane. The

direct pooling into venous sinuses of brain via inferior ophthalmic veins. Absorption

directly into the cerebrospinal fluid.

Apart from the smallemmisary veins entering cavernous sinuses of the brain, a

pair of venous branch emberiging from alaenasi will drain into facial vein. Just almost in

the opposite direction inferior ophthalmic veins also enter the facial vein. These

opthalmies in other hand also drain into cavernous sinuses of the meninges and in

addition nither the facial vein not the ophthalmic veins have any veinal valves. So there

are more chances of blood draining from facial vein into the cavernous sinus in the

lowered head position.

The nasal cavity directly opens with the frontal maxillary and sphenoidal air

sinuses epithelial layer is also continuous throughout them. The momentary retention of

drug in nasopharynx and suction causes oozing of drug material into air sinuses. These

sites are rich with blood vessels entering the brain and meninges through the existing


Sweda karma

72

foramins in the bones. Therefore, there are better chances of drug transportation in this

path. The shringhataka marma has been explained by recent authors as ‘middle cephalic

fossa of the skull consisting paranasal sinuses and meningial vessels and nerves. One can

see into the truth of narration made by Vagbhata here. The drug administered enters the

paranasal sinuses especially frontal and sphenoidal sinuses i.e, shringhataka where the

ophthalmic veins and the other veins spread out. The sphenoidal sinuses are in close

relation with intracranial structures. Thus there may be a so far undetected route between

air sinuses and cavernous sinuses enabling the transudation of fluids. As a whole, the

mentioning of the shringhataka in this context seems to be more reasonable.

ABSORPTION OF DRUG

The drug may be absorbed initially by ‘passive process’ across the cell wall. Any

lipid soluble substance has greater chance for passive absorption directly through the

lining of cell membrane. Then the later transversion may be carried through capillaries

and veins. Usually the Nasya consists of Snehadravya, as strongly recommended by the

Ayurvedic texts. Modern science states that the greater the lipid water coefficient, the

concentration of drug in the membrane and the faster is its diffusion. The partion

coefficient is also dependent upon the temperature of the moment of administration.

Hence, the rised temperataure due to hot fermentation may help in this active process.

In the conclusion it may be stated that, the nose is the doorway to the brain and it

is also path to consciousness. Pran of life energy enters the body through the breath taken

in, through the nose, Nasal administration helps to correct the disorders of prana affecting

the higher cerebral, sensory and motor functions. The brief study of mechanism of

Nasyakarma can be summed up in a single statement made in the Ayurvedic classics

‘Nasahi Shirasodwaram’. I.e, nose is the pharmacological passage into the head.


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Twak shareera

Ayurveda has recognized twak as an upadhatu of mamsa151. The twak is a

modification of mamsadhatu in its developmental state i.e. during intrauterine life152.

Sushruta described the seven layers of twak and the diseases arising from the twak153.

The following table shows the thickness of the seven layers of twak and the

diseases arising from them.

Table No. 26. Showing the different layers of twak

Sl. Layer of twak Size Diseases arising from each layer

1 Avabhasini 1/18 Vrihi Sidhma, Padma, Kantaka

2 Lohitha 1/16 Vrihi Tilakalaka, Nyaccha, Vyanga

3 Swetha 1/12 Vrihi Charmadala, Ajagalli, Mashaka

4 Tamra 1/8 Vrihi Kilasa, Kushta

5 Vedinee 1/5 Vrihi Kushta, Visarpa

6 Rohinee 1 Vrihi Granthi, Apachi,

Arbuda, Shlipada, Galaganda

7 Mamsadhara 2 Vrihi Bhagandara, Vidradhi, Arshas

According to Sushruta, these seven layers of twak are formed, as the

cream is formed layer after layer in the boiling milk.

Charaka slightly differs from Sushruta and had described only six layers

of twak without naming them154. Order of these six layers is 1) udakadhara, 2) asrigdhara,

3) sidhma-kilasa sambhavadhishthana, 4) dadrukushta sambhavadhishthana, 5) alaji-

vidradhi sambhavadhishthana and 6) arumshika adhishthana. Among these if, the


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74

innermost layer i.e. arumshika adhishthana is injured the patient goes into shock and

develops a very serious skin disease called arumshika, a type of boils on the phalanges

and elbow joint.

Bhrajakapitta, one among the panchavidha Pittas, is located in the twak. It is this

bhrajakapitta that takes up and metabolizes the drugs applied in the form of abhyanga,

parisheka, avagaha, alepa155 etc.

Modern View

Most of the modern scientists recognize the possibilities of considering skin as a

Large, Highly Complex Organ and as a Structuraly Integrated Organ System. The

components of the integumentary system are the cutaneous membrane or skin and the

associated hairs, nails and exocrine glands. The system accounts for about 16% of ones

body weight156.

Cutaneous membrane has two components – the superficial epithelium or

epidermis and the underlying connective tissues of the dermis. The associated or

accessory structures are located in the dermis and protrude through the epidermis to the

skin surface. Function of the skin is supported by an extensive network of blood vessel

branches (through the dermis) and sensory receptors that monitor touch, pressure,

temperature and pain. The loose connective tissue of the subcutaneous layer or superficial

fascia or the hypodermis which lies beneath the dermis separates the integument from the

deep fascia around the other organs such is muscles and bones.


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General functions of the skin

• Protection of underlying tissues and organs.

• Excretion of salts, water and organic wastes.

• Maintenance of normal body temperature.

• Synthesis of a steroid, vitamin D3 that is subsequently converted to the hormone

calcitriol, important to normal calcium metabolism.

• Storage of nutrients.

• Detection of touch, pressure, pain and temperature stimuli and the relay of that

information to the nervous system.

Sweda and Swedavahasrotas

Sweda is produced from medodhathu as a mala during dhathuparinama157.

When the body becomes hot, the udaka that comes out from the romakupas is called

sweda158. Sweda is an apyadravya159. Sweda is brought to the surface of the skin through

the swedavaha srotases by the action of vyanavata160. The excretion of the sweda

bestows moisture and delicate nature to the skin161. According to Hemadri, the hair on

the skin is supported by the sweda162.

Medas and romakupa are the moolas of swedavaha srotas163. They get vitiated due

to ativyayama, atisantapa, indiscriminate indulgence in cold and heat, krodha, shoka and

bhaya164. Their vitiation produces the following lakshanas- aswedana (anhydrosis),

atiswedana (hyperhydrosis), parushya (roughness of the body), atislakshnata (excessive

smoothness of the body), paridaha (general burning sensation) and lomaharsha

(horripulations)165.


Historical review of Manyasthambha

77

HISTORICAL BACKGROUND OF MANYASTHAMBHA

The disease references are much available in Vedas and Samhita as only Vata

vikara. It is evidential that there is no direct reference of the disease as Manyasthambha is

available from vedic literature, but can definitely find indirect references here and there.

In the Rigveda and Atharvana Veda we can see the details of Vata bheda, Sleshmaka

Kapha166. Sandhi Vyadhi and medicines used in Vata Vyadhi. The references are found

from Bhruhatrayes and Laghu trayees many more about the disease Manyasthambha.

Manyasthambha is highlighted in early 20th century and even they have mentioned the

Shodhana and Shamana line of managements.

Charaka Thrimarmeeya chapter of Siddhi Sthana167, he explained

Manyasthambha is because of head injury i.e. shiro abigatham and considered

“Antharayama” as Manyasthambha. Similarly Vagbhata168 also refer Manyasthambha is a

symptom of “Antharayama”. In further while explaining the Nasya vidhi, he has

indicated Nasya especially Brumhana Nasya for Manyasthambha169.

Susruta Samhita dealt Manyasthambha as the prodromal symptom of Apathanaka,

a Vata Vyadhi. But Gayadasa, commentator of Susruta, considers Manyasthambha as

individual disease entities because of its causative factors are discussed separately as a

disease170,171.

Later texts of Ayurveda Madhava Nidana172, Bhavaprakasha173 and

Sharangadhara174 Samhita dealt Manyasthambha as individual disease by discussing its

detailed pathology along with its specific line of treatment. Chakradutta175, Vangasena176

and Bhaishajaya Ratnavali177 also discussed Nidana and treatment for Manyasthambha as

an individual entity of disease.


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78

At the present day of context, the contemporary science explains elaborated

description of cervical Spondylitis, which is a inflammatory and degenerative disease,

has been studied under a separate branch named as Rheumatology linked with the bonny

lesions178.

Etymology of Manyasthambha

The Manyasthambha comprised of two meaningful words, Manya and sthambha,

which makes the meaning of stiffness of the neck muscles. It clearly states the

pathogenesis of the neck and its contents. The derivation of the Manyasthambha is as

follows179.

“Manya” means the back of the neck or the part below the head, manya and

Greeva are synonyms.

“Sthambha” relays the meaning of stopping or retarding the functions of the neck

i.e. inability of neck movements

With the above stated definitions and derivations we can draw a conclusion as

such the disease Manyasthambha is a disease of the neck where the movements are

restricted or disturbed because of the underlying pathology. The pathology is either

inflammatory, degeneration or due to local pathological entities, either because of the

internal humoral vitiation or exogenic factors180.

Paribasha181

Vata is vitiated either because of Avarana or Dhatu kshaya. When Vata covered

by Kapha or Dosha accumulation makes Manyasthambha. Even though Manyasthambha

is told as a vataja nanatmaja Vata Vyadhi Kapha Dosha associations are also inscribed in

the Samprapti.


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79

This is because the Vata is vitiated and lodging in the Kapha sthana so the Kapha

involvement can occur. When any disease is not treated properly at the initial stage it may

lead to further deterioration. Such activity is happening even in Manyasthambha too. At

the initial stage of the disease the Kapha Anubandhatwam is acknowledged. When it

becomes chronic, it becomes as a total Vata disorder, which is degenerative condition in

nature.

Surface Anatomy of the disease concern

Vertebral column182,183,184

The total numbers of bone present in the body are together called as skeleton. The

main division of skeleton is into axial and appendicular. The axial skeleton includes

vertebral column, sternum, ribs, and skull. The appendicular skeleton includes these

bones of the upper and lower limbs and girdle bones. The vertebral column extends from

the base of the skull through the whole length of the neck and trunk. It consists of thirty

three separate irregular bones called vertebra placed in series and connected together by

ligaments and discs of fibro-cartilage to form a flexible curved support for the trunk.

The vertebral column varies length but it is about 70cm in man and 60cm in

women. Th vertebra is named according to region in which they lie. They are 7 cervical,

12 thoracic, 5 lumbar, 5 sacral, 5 coccygeal.

With the exception of the first two cervical vertebrae all other vertebra consists of

a large anterior weight bearing body and a posterior placed vertebral arch. The arch

springs from the postero-lateral aspects of the body and with its surrounds large hole,

vertebral foramina. When the vertebra are placed in series these foramina together with


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80

the ligamenta flava, that unite the adjacent laminae form the vertebral canal which lodges

the spinal chord with its meaning and blood vessels.

Atlas (first cervical) vertebra

The first cervical vertebra is called the atlas it looks very different from a typical cervical

vertebra as it has no body and no spine. It consists of two lateral masses joint anteriorly

by a short anterior arch, and posteriorly by a much longer posterior arch. The arches give

the atlas a ring like appearance. The large transverse process pierced by a foramen

transversarium, projects latterly from the lateral mass. The superior aspects of each lateral

mass shows an elongated concave facet, which articulates with the corresponding condyle

of the occipital bone.

Cervical vertebrae (C1-4) Postrio-superior view


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The axis (second cervical) vertebra

The most conspicuous feature of the axis, which distinguishes it from all

othervertebra, is the presence of a thick finger like projection arising from the upper part

of the body. This projection is called the densor odontoid process. The anterior aspect of

the dens bears a convex oval facet for articulation with the anterior arch. Its posterior

aspect shows a transverse grove for the transverse ligament. The pedicles, laminae and

spine are the thick and strong, the inferior articular facets are placed below the junction of

the pedicles and the laminae.


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Cervical vertebrae (C2-T1) Right-Lateral view

The seventh cervical vertebra

The seventh cervical vertebra differs from a typical vertebra in having a long thick spinus

process, which ends in a single tubercle. The tip of the process forms a prominent surface

landmark. Because of this fact this vertebra is referred to as the vertebra prominence.

The transverse processes are also large and have prominent posterior tubercles. In

this vertebra the vertebral artery and vein do not transverse the foramen transversarium of

this vertebrae an accessory vertebral vein passes through the foramen.

Anatomy of inter vertebral joints

All vertebrae from 2nd cervical to 7th cervical vertebrae articulate by cartilaginous

joints between their bodies, synovial joints between their articular process

(Zygapophysical) and fibrous joints between their laminae and also between their

transverse and spinous process.

Inter-vertebral disc

It is a fibro-cartilagenous disc, which bends the two adjacent vertebral bodies,

except the axis. Morphologically it is a segmental structure as opposed to the vertebral

body, which is inter-segmental.

Inter-vertebral discs Shape: The shape of the inter-vertebral disc corresponds to that of

the vertebral bodies between which it is placed.

Inter-vertebral discs Thickness: It varies in different region of the column and in

different parts of the same disc. In cervical region the disc are thicker in front than

behind.


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Structure of inter-vertebral disc: Each disc is made up of three parts, viz., Nucleus

pulposes, annulus fibrosus and cartilaginous plate. The individual component description

is as follows.

Nucleus pulposus: It is the central part of the disc, which is soft and gelatinous at birth.

Its water content is 90% in newborn and 70% in old age. It is kept under tension and acts

as a hydraulic shock absorber. It represents the remains of the notochord and contains

few multi nucleated notochordal cells during the first decade of life. After which there is

a gradual replacement of the mucord material by fibro cartilage derived mainly from the

cells of annulus fibrosus and partly from the cartilaginous plates covering the upper and

lower surfaces of the vertebrae. Thus with advancing age the disc becomes amorphous

and difficult to differentiate from the annulus. Its water binding capacity and the elasticity

are reduced.

Annulus fibrousus: It is the peripheral part of the disc made up of a narrower outer zone

of collagenous fibres and a wider inner zone of fibro cartilage. The laminae form

incomplete collars, which are convex downwards and re corrected by strong fibrous

bands. They overlap into one another at obtuse angles. The outer collagenous fibers bend

with anterior and posterior longitudinal ligaments.

Cartilaginous plate: Two cartilaginous plates lie one above the other below the nucleus

pulposes. Disc gains its nourishment from the vertebrae by diffusion through these plates.

Function of inter-vertebral discs: Inter-vertebral discs give shape to the vertebral

column. They act as a vertebral series of shock absorbers or buffers. Each disc may be

linked to a coiled up spring.


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Movements of the cervical column: Range of movements between vertebrae is

restricted by the limited deformities of inter-vertebral discs. Whose greater thickness at

cervical column increases individual range. It is also limited by the topography of the

zygophysial joints and by concomitant changes in tension of the ligamentous

syndesmoses. Thus the total range of vertebral movement includes flexion, extension,

lateral flexion rotation.

Flexion: In flexion the anterior longitudinal ligaments become relaxed and the anterior

part of inter-vertebral discs are composed. While at its limit the posterior longitudinal

ligament ligamentum flora, inter-spinous and supra-spinous ligaments and posterior

fibres of intervertebral discs are tensed.

Extension: In extension the opposite event of flexion occurs. Tension of the anterior

longitudinal ligament, Anterior disc fibres and approximation of spines, zygopophyses

and compression of posterior disc fibres, limits extension.

Lateral flexion: Here the inter-vertebral discs are laterally compressed and contra-

laterally tensed and lengthened motion being limited by tension of antagonist muscles

and ligaments. It is always combined with rotation, lateral movements occur in any part

of the column but are greatest in cervical and lumbar region.

Rotation: Rotation involves twisting of vertebrae relative to each other, with torsional

deformation of intervening discs. Movement is slight at cervical level.

Neuro anatomy

Cervical plexus185,186

The cervical plexus is formed by the vertebral rami of the upper four cervical

nervous. The rami emerge between the anterior and posterior tubercles of the cervical

transverse processes, grooving the costo transverse bars. The four roots are with one

another to form three loops.


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85

The plexus is related posteriorly to the muscles, which arise from the posterior

tubercles of the transverse process i.e., the Levator scapulae and the scanlenus medius.

Anteriorly to the pre-vertebral facia, the interior jugular vein and sterno mastoid.

Branches

A) Superficial cutaneous branches

Lesser occipital (c2)

Greater auricular(c2,c3)

Transverse (anterior) cutaneous nerve of the neck (c2,c3)

Supra clavicular (c3,c4)

B) Deep branches

Communicating branches

Muscular branches

o rectus capitis anterior from c1

o rectus captis lateratus from c1,c2

o longus capitis from c1,c2,c3

o lower root of anasa cervicalis c2c3

Muscles supplied by cervical branches

Stermomastoid – c2 and accessory nerve

Trapezius – c3-c4

Lavetor scapularis – c3c4c5

Phrenic nerve c3c4c5

Longus colli c3-8

Scalenus medius c3-8

Scalenus anterior c4-6

Scalenus posterior c6-8

Phrenic nerve

This is a mixed nerve and carrying motor fibres to the diaphragm and sensory

fibres from the diaphragm, the pleura, the pericardium, and part of the peritoneum.

Origin: It arises chiefly from the 4th cervical nerve but receives contributions from c5

may come directly from the root or indirectly through the nerve to the subclavius.


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Nidana – the aetiology of Manyasthambha

Nidana is defined as ‘Vyadhi Uttpatti hettu nidanam” This is the main cause for

the occurance of a disease. This makes us to ascertain the diagnosis, helps to provide

proper treatment and Nidana Parivarjna is one of the important measures in chikitsa.

As the Manyasthambha is a Vata Vyadhi, the Vata Vyadhi Nidana has to be

considered here. Manyasthambha is one among the eighty types of Vata disorders. There

is no much difference in the causative factors of Vata diseases. Only due to Samprapti

Vishesha of vitiated Vata will leads to variety of Vata disorder like Ardhita, Pakshagata,

Manyasthambha etc., the factors which causes vitiation of Vata are classified under the

following sub headings.

Swaprakopaka Nidana

Margavarodhaka Nidana

Marmaghatakara Nidana

Dhatukshayakaraka Nidana

The etiological factors having some properties of Vata causes increase of Vata.

According to Samanya Vishesha Siddhanta, the principle of the doctrine is the

combination of similar brings about vrudhi and the dissimilar to kshaya187. Further

excessive and constant consumption of the same etiological factors results in to

provocation of Vata. Apart from these the factors which favours the provocation of Vata

are also to be considered here. These etiological factors are classified as follows.


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Swaprakopaka Nidana

Ahara (dietetic factors)

Excessive and continuos in take of diet possessing the properties of ruksha,

Sheeta Laghu, and rasas like Katu, Tikta, Kashaya, irregular food habits, in sufficient

diet, intake of dried leafy vegetables, dried food articles, cereals like varaka, kodrava,

pulses like syamaka, mudga, kalaya, chanaka, harenu.

Vihara188

Ratri jagarana, excessive walking, excessive swimming, excessive riding on

horses and vehicles, ativyavaya, prapatane (talking) adhyasana, bharavahana (weight

lifting) ativyayama (excessive exercise) balavat vigraha, (fighting with persons of

superior strength).

Seasonal factors and Vayah

Rainy season and part of the summer season. End part of the day, night, digestion

are the seasonal which makes Vata prokopa in the old age Vata Dosha is dominant makes

Dhatu kshaya (degenerative changes)

Mithyo pachara of Pancha karma189

Improper doing of Vamana, Virechana, Vasti etc., the term denotes has atiyoga as

well as heena yoga. The wrongly carried out methods cause vitiation of Vata Dosha.

Psychological factors190

Due to worry, grief, anger, fear, anxiety, the body becomes emaciation causes

Vata vitiation.

Margavarodhaka Nidana

The etiological factors which causes obstruction in the normal movement of Vata

results in the prakopa of Vata.


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Vegha dharana and udheerane191

Suppression of natural urges and inducing the urges forcefully causes Vata

prokopa.In Manyasthambha these factors causes prakopa of Vyanavata, a sthanika Dosha

may aggravate the condition. Example : Due to the suppression of sneezing, headache,

debility of the sence organs , stiffness of the Neck (Manyasthambha) and facial paralysis

occur.

Ama

Due to hypo functioning of Agni, the food that is not completely digested, yields

immature Rasa in Amashaya, obstructs the Vatavaha Srotas, causes the vitiation of Vata

and moves around in different directions to produce a Vata Vyadhi.

Other Doshas

Manyasthambha is told as Vata kaphaja even though it is included in Vataja

nanatmaka Vyadhi. Here Kapha Dosha involvement is present. The Kapha prokopa ahara

nidanas causes the obstruction of Vata makes sthanika disease.

Kapha prokopa factors

Ahara: Excessive and continuous usage of sweet, acidic, salty, cold and heavy food

articles like yavaka, black gram, curd, milk, nava danyas. Anupa mamsa etc.,

Vihara: Day sleep, excessive sleep, suppression of vomiting

Marmabhigata: Injury to neck causes Vata prakopa resulting kshata of the manya siras

and asthi bramsa, hence it results in to the loss or restriction of neck movements. The

etiological factors such as carrying heavy weight over head, sleeping in irregular surface,

etc, can cause the marmagata in the neck region192,193.


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Dhatu kshaya kara Nidana

The Dhatu kshya can arise due to various etiological factors. The Dhatu kshya

causes increase of rukshata thus prakopa of Vata. Dhatukshaya occurs usually during

vardakya, because at this stage dhatus are in hriyamana stage, deterioration of dhatus

vitiates vatadosha which inturn leads to manya stamba. Here datukshaya can

beinterpreted interms of degenarative changes found at the site of disease manification,

which are primarily due to ageing process. In old age due to the degeneration of the discs

increases pressure on nerve roots by which nerve roots of the vertebra is compressed and

the compression of vertebra is causing Manyasthambha. Excessive indulgence in exercise

or sex causing Dhatu kshaya is also a cause of Vata prakaopa leads to Manyasthambha.

Comparison of Manyasthambha Lakshana.

After viewing general nidanas of vatavyadhi in short, we will switch onto specific

etiological factors of Manyasthambha. As described by different authors of causes of

Manyasthambha are listed in the table.

Table No. 27. Showing the incidence of Nidana of Manyasthambha according to

different Acharyas.

SN Nidana Sushruth Madava nidana Bhavaprakash Yogaratnakar

1 Diwaswapna + + + +

2 Asanasthana vikruthi + - + +

3 Urdwanireekshana + - + +


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Divaswapnam

“ Diwaswapanam ithi rathrijagaranam”

As it is defined by Bhavaprakasha ‘ one who does rathrijagarana day sleep during

day time’ but at this juncture it would be better to specify how does it become an

etiological factor for manyasthambha. as we all known Divaswapnam causes Kapha

prakopa, which is involved in early stages of the disease to be more specific. It can be

interpreted in terms of sleeping in bad postures. Which causes minor trauma to the

cervical spine and leads Manyasthambha.

Asanasthana Vikruthi194,195,196,197

“Asanam Upaveshanam, sthanam urdvibhavanam”.

“Asanena sthanena va-athishayena vikrutham greeva-adi vikrutha.”

Here Asana as upaveshanam and sthana as urddwa vibhavanam, which means the

postural disturbances specifically with reference to sitting. Persons sitting or even lying

down in bad postures, which in turn leads to improper positioning of cervical vertebrae,

this puts uneven pressure over the spinal nerve roots producing different signs and

symptoms. We know that when a person sits or sleeps in improper head positions, if that

person is of middle age or old aged as he has already developed degenerative changes in

the cervical vertebrae. Which is due to ageing process, hence a wrong posture cause

minor trauma accelerates the pathology of degeneration leading to set of clinical features.


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Urdwa Nireekshana198,199,200,201

Vivrutha urdwa neereekshanaihi vakramargavolokanaihi

Dalhana clarifies that by looking upwards continuously is vakra position of

manya leads to minor trauma and precipitates the symptoms. In Charaka Samhita

abigathwam of siras has told one of the reason for Manyasthambha.

Aetiology of Cervical spondylitis

In addition to age and possibly gender, several risk factors have been proposed for

cervical Spondylitis. Repeated occupational trauma (e.g., carrying axial loads,

professional dancing, and gymnastics) may contribute. Familial cases have been reported;

a genetic cause is possible. Smoking also may be a risk factor. Conditions that contribute

to segmental instability and excessive segmental motion (e.g., congenitally fused spine,

and cerebral palsy, Down syndrome) may be risk factors for spondylotic disease. Very

stiff muscles in the cervical region can, over the years, cause a kinking of the cervical

spine to the front. Bad posture and lack of exercise to the cervical region are the key

factors which are responsible in a majority of the patients.

Lying in bed with several pillows propping up the neck into an unnatural position

can affect the alignment of the cervical column, causing a forward inclination. Reclining

on sofas with the spine hunched and the neck pushed forward is bad for cervical

alignment. Hunching over the computer for many hours, occupational hazards such as

those of a writer, an illustrator or a painter, all cause the spine to be bent forward all the

time. Positioning the body to the same side during sleep, with the shoulder muscles and

the neck compressed, also develops faulty alignment in the cervical spine.


Manyasthambha

92

In due course the spine is bent, the front surface of the bones and disc are

excessively pressurised and damage occurs. The so-called executive chairs are ill-

designed and push the neck out of alignment. No chair should reach over the head. The

level should be up to the shoulder blades so that the chest can stretch over the edge

keeping the body upright.

In India, railway porters carry heavy loads on their heads but they do not suffer

from cervical pain (as one would expect) from the heavy load they carry every day. Only

in the group of people who never exercise their bodies does this occur most frequently.

In the modern science they described severe trauma such as suddenly turning the

head, continuously looking upwards, repeated movements of cervical vertebrae, desk

work, clinical work, weight lifting etc., causes for cervical Spondylitis. Apart from the

above age is obviously the most important predisposing factor. Etiological factors

according to modern202

1) Postural causes

Drooping shoulder

Condition in the muscles fascia, ligaments and glands

Trauma

Occupational strain

2) Condition of the cervical spine

Inter vertebral disc prolapse

Lesions in the vertebral bodies

Trauma: old fractures, dislocation, subluxations

Tuberculosis

Tumour deposits

Ankylosing Spondylitis


Manyasthambha

93

3) Intra-spinal conditions

Cord tumours

Syringomyelia

Extradural tumours

Shoulder lesions

Peri-arthritis

Supra spinatus tendnitas

Sub deltoid bursitis

4) Reffered pain

Cardiac ischemia can cause left sided brachial neuralgea

Sub-diaphragmatic lesions like gall bladder lesions cause right sided pain

5) Systematic cause

Diabetic neuropathy

Manyasthambha Samprapti

The study of samprapthi is the most important aspect of understanding the

disease. It explains the complete disease process which starts immediately after nidana

sevana. It includes the explanation about the dearrangement of Doshas and the

pathological changes that takes place in a person leading to the formation of the diseases

and also the mode of manifestation of clinical features. Further more it aids the treatment

too.

In our classic it’s samprapti is explained as follows: Due to nidana sevana vata

gets vitiated and gets avrutha by kapha which interms does sthabdatha of 14 manya shiras

situated in the back of neck and results in Manyasthambha.

Samprapti is a series of pathological changes takes place in the body from day of

development of the disease till to complete manifestation and establishment of the disease

with its complications. The knowledge of Samprapti is very much essential from Chikitsa

point of view and it also helps to understand complete pathogenesis of a disease, as it has


Manyasthambha

94

told by our Acharyas. “Samprapti vightanameva Chikitsa”, which means systemic

breaking of Samprapti is called Chikitsa hence a proper knowledge of Samprapti along

with its ghatakas is very much essential. An elaborate description of Samprapti of

Manyasthambha is not available in the classics.

The Vata Dosha along with Kapha Dosha get vitiated and take asraya at manya

pradesha affecting the manya siras causing sthambana and ruja of neck. Bhavamishra

explained the pathogenesis of Manyasthambha elaborately but he did not describe the

pathological structural changes in the articular cartilage disc and vertebrae. Vata prakopa

Nidanas mentioned like datukshya, which mainly occur during the mid and later decades

of life time can be interpreted in terms of degenerative changes found in the cervical

spine and disc which is the resultant of ageing process mentioned in the ailed science.

Second one is due to margavarodha. The Nidanas like adhyaashana, vishamasana

(Urdhwa Nireekshana, asmasthama sayanam) and other Ama kara Nidanas vitiated first

Agni leading to manda Agni and production of Ama causing margkavarodha in this way

all the above Nidanas will causes Vataprakopa either by datukshya or margavarodha.

While describing Samprapti of Manyasthambha (cervical Spondylitis) it should be under

stood in this manner.

When we go though the pathological changes found at cervical spine, the change

in the ligamentum flavum, which is indicative of early stages of disease. Here at this

initial stage we can expect the involvement of Kapha.

In the latter stage it involves nerves roots and even spinal cord, which is attributed

solely to Vata vitiation. In some patients we can find shotha localised part and in the


Manyasthambha

95

allied science they claim that swelling is found in early stages i.e., cervical Spondylitis,

which is suggestive of vitiation of Kapha.

When the due course all diseases are not treated properly it leads to Vatic in

nature. In the initial stage we can accept the involvement of Kapha in Manyasthambha

(Cervical Spondylitis) but the latter stage, we find the compression of nerve root due to

ostyophytes changes producing different signs and symptoms which are collectively

termed as Manyasthambha (Cervical Spondylitis). It can be attribute the role of Vata

Dosha and there is minimal or no involvement of Kapha.

Samprapti Ghatakas

Showing the schematic Representation of Manyasthambha Samprapti

Vaya and Nidanas

Diwaswapna, Asanasthana sayanam Vata prakaopa

Urdhwanireekshana

Sleshmavarana

Stana samshraya in manya siras

Kupitha Vata

Manyasthambha


Manyasthambha

96

The knowledge of Samprapti gataka is very much essential while treating a

disease because systematic breaking of pathogenesis as Samprapti is known as treatment

of a particular disease

♦ Dosha : Vata- Vyanavata

♦ Kapha : sleshma Kapha

♦ Dushya : asthi, majja, sanyu, mamsa,

♦ Agni : jatara Agni mandya janya Ama,

asthi dhatuagni mandya janya Ama

♦ Srotas : asthi vaha Srotas

♦ Sroto dusthti : sanga

♦ Udhbhara sthama : pakwasaya

♦ Sanchar sthana : rasayani

♦ Roga marga : madhayama rogamarga

♦ Adhishtanam : manya pradesha

♦ Vyaktha sthana : manya pradesha

Purvaroopa203

Poorva rupa are the premonitory symptoms, which occur before the complete

manifestation of a disease. Commonly all disease will show some premonitory symptoms

before the disease develops but there are no such premonitory symptoms of

Manyasthambha are mentioned in the classics but In general before manifestation of

Manyasthambha vitiated Vata will show its symptoms in the body. This includes mild

pain in the neck and also stiffness of neck.


Manyasthambha

97

Roopa204

The term roopa implies both signs and symptoms, which plays a very important

role in the diagnosis and management of the disease. The lakshana develops after the

poorvaroopa as the Samprapti (pathology) advances from sthana samshraya avastha to

vyaktha vastha. At this stage, the Dosha- dushya sammurchana becomes continuous and

the total signs and symptoms are observed. In this stage of Sammurchita Dosha ruk (pain)

and Stambha (stiffness) becomes the only signs and symptoms told in the classics as

Lakshana pertaining to the Manyasthambha is visualized. These can be classified in

association with the other symptoms as under with different headings, which we don’t

find in the classics. They are -

1 Asymptomatic

2 symptomatic

Symptomatic stage can be classified in to -

1. Pain restricted to only manya pradesha

2. Pain radiating down to the arm, fore arm, hand and fingers

Asymptomatic stage

In the classics, Asymptomatic stage is described as the vrudhvastha. The dhatus

will becomes ksheena, which is a quite natural process in which the Dhatus becomes

degenerated as age progresses. Occasionally, few people in spite of appearing these

changes will not show any significant signs and symptoms related to the stage of

Asymptomatic, as there is no involvement of the nerve root. In modern science they

explained as follows the vertebra of most people past 50 years of age shows some


Manyasthambha

98

evidence of a degenerate changes. It is important to realise that such finding may be

Asymptomatic and of no clinical significance.

Symptomatic stage

It can be classified as a localised pain in manyapradesha and radiating pain down

the arm, fore arm, hand, and fingertip according to the site of the pain. This classification

is made on the basis of Manyasthambha pathology involved with the signs and

symptoms. Pain is the symptom produced due to involvement of different anatomical

structures in the disease process. Hence minimal involvement reflects with pain restricted

only to manya pradesha and in the advanced cases, it even involves special nerves, which

causes the radiation of pain down to the arms depending upon the involvement of nerve

root segments.

Here the presenting symptom will be stiffness of neck i.e., sthamba of manya. The

sthamba is the resultant of spasticity of neck muscles, which stretches and make neck

stiff. Vedana in manya pradesha are manya shoola, this is outstanding clinical symptoms

in all most of all patients.

Symptoms205

The most common symptom is pain in the neck, worsening with exertion and

relieved, in the early stages, by rest. This pain often radiates down to the hand, with the

fingers becoming numb due to compression of the nerves that innervate the upper

extremity. The brachial plexus is affected. The trapezius area becomes tender and painful.

A nodule can form in the muscle due to chronic pressure.

The symptoms of cervical cord compression can sometimes be severe. The pain

radiates down the right or left arm to the fingers, to the chest and shoulder blades


Manyasthambha

99

depending on which side the nerve root is involved. It can become continuous, making

movements painful and limited. If the cervical vertebrae become unstable, the danger of

cord compression is imminent and, in some cases, fusion of the bones may be warranted.

But this is rare.

Clinical aspects206

The signs and symptoms produced are the results of nerve root compression, spinal cord

compression, or both. The most common complaint is neck pain, which limits its motion

and is aggravated by neck extension. Pain also may radiate in one arm in a pattern

Characteristic of the particular root involved.

Table No.28. Level of disc herniation

Manifestation C4-C5 C5-C6 C6-C7 C7-T1 Root Compressed

C4 C5 C6 C7

Weakness Deltoid Biceps Triceps, wrist, Extension

Hand Intrinsic wrist flexion

Sensory loss Lateral shoulder

Lateral arm forearm, thumb, lateral aspect of finger

Middle finger Ring and little Finger

Reflex involvement

Deltoid pectoralis

Biceps Triceps Finger flexion

Vyavachedaka Nidana

Sapeksha nidana or differential diagnosis plays a prime role in arriving at a exact

decision between diseases presenting a similar clinical feature which helps for the

pinpoint diagnosis and treatment.


Manyasthambha

100

This disease can be differentiated from following diseases.

Vishwachi

Avabhahuka

Acharya Sushruta explains viswachi as that which causes karmakshaya of bahu

due to the dusti of kandara which runs from bahu prista towards talabhaga of hasta and

angulies. Vitated vata when gets lodged in bahushira causes Apabhahuka described by

Acharya Bhava prakasha.

Upashaya and Anupashaya

In the process of investigating the disease Upashaya methods that is therapeutic

trails with certain diet, drug activities are also considered as a tool in some cases. As

there is no Upashaya and Anupashaya for Manyasthambha mentioned in the classics. But

we can select the Vata Vyadhi Upashaya.

Manyasthambha comes under the Vata Vyadhi some of the observations done

during clinical trials are listed as cold breezes, continuos work morning hours, weight

lifting as Anupashaya for Manyasthambha. Abhyanga, sweda, rest, avoiding pillows are

considered as Upashaya. Even in the contemporary science they have described the hot

massage relieves the pain which is as Upashaya.

Upadravas, Arista Lakshana and Sadyasadhyata

When we go through the classics there is no mentioning of above factors in the

context of Manyasthambha. Hence we can consider the description which is available in

vatavyadi in general.

In allied science complications of Cervical Spondylitis has been explained that is

“If the spinal canal is markedely narrowed by osteophytes the spinal cord may be


Manyasthambha

101

damaged, with progressive upper motor neurone disturbance affecting all the fourlimbs

and possibly the bladder. The complication is serious but uncommon.

Pathya-Apathya

Pathya is defined as ‘Pathona Petham Pathyam’,

Pathya is one which is suitable to the body, mind and to all Srotase’s in healthy as

well as diseased condition.

There is no special Pathya and Apathyas mentioned for Manyasthambha. As it is

mentioned in the list of Vata Vyadhi, general regimen of diet and other habits mentioned

under this can be adopted in Manyasthambha and they are as follows:

Table No. 29. Showing the Pathyaapathyas in Vatavyadhi:

Factors Pathyas Apathyas Sneha and others Sarpi, vasa, taila, majja, gritha,

dugdha, kilata, dadhikurchika -

Harita, Shakha, Shimbhi and phala varga

Kulatha, Masha, godhuma, Raktishli, patola, vartaka, dadima, parushaka, badara, Iashuna and draksha.

Chanaka, kalaya, shyamaka, karuvinda, nivara, kangu, mudga, rajamasha, guda, jambuka, kramuka, Mirnala, nishpava, Taalaphala, asthimajja shimbi, shaka, udumbara.

Mamsa varga Chataka, kukkuta, tittira, shilindhra, nakra, gargars, khudisha, Bileshaya

All jangala mamsa varga.

Rasa Pradhana Madhura, Amla, Lavana Kashaya, Katu, Tikta Mansika Sukha Chinta, Prajagara Vihara Snehana, swedana, snehapana, snana,

Abhyanga, Rechana, Mardana, basti, Avagahana, Samvahana, Samshamana, Agni karma, Upanaha, Tailadroni, Shirobasti, shamana, Nasya, santarpana and Brimhana

Vyavaya, Ativyayama, Basti, Ashva yana, Chankramana, Vegadharana, chardhi, Shrama, anashnata, Gurunadi sheetalam.


Manyasthambha

102

Ayurvedic line of management

Susruta says Nidana parivarjana is Chikitsa. But Charaka has further amplified the scope

of Chikitsa by saying, Chikitsa aims not only the less exposure to the causative factors of

the disease, but also at the restoration of Doshic equilibrium. Manyasthambha being

Vataja Vyadhi, treatment of Vata Vyadhi can be adopted. But, specific line of treatment

is described for Manyasthambha.

Chikitsa sutra of Manyasthambha

The steps and procedures to be adopted in the management of the Manyasthambha are

as follows.

1. Rooksha Sweda

2. Panchamoolakwatha or dasamoolakwatha sevana

3. Nasya karma

Table No.30. Chikitsa of Manyasthambha according to different Acharyas are

depicted as under.

CHIKITSA Bhava Prakasha

Yoga Ratnakara

Susruta Samhita

Bhaishajya Ratnavali

Chakradutta

Sneham + - + - - Swedam + + - - - Nasyakarma + + + + - Nasapanam - + - + +

Bhava Mishra mentions that the Abhyanga with thaila or grutha should be done in

Manyasthambha. Bhavaparakasha and Yogaratnakara indicate Rooksha Sweda and

Nasya. Bhaishajyaratnavali and also Chakradutta indicate Mahamasha yoga Taila

Nasapanam (Nasya) in Manyasthambha. Mahamasha Taila even can be used as pana i.e.

internal medication, which is the present dissertation topic. Apart from the above


Manyasthambha

103

mentioned specific management, as the disease is a Vata Vyadhi Vata Chikitsa sutra and

methodologies of the pacifying measures of Vata are also adaptable.

Management of cervical Spondylitis in contemporary science

Medical science accepts cervical spondylitis as a normal degenerative aging

change. Painkillers are prescribed. In order to prevent the symptoms of vascular

insufficiency, anti-platelet drugs are given to maintain cerebral blood flow. This makes

the platelets less sticky, the blood thinner and helps better flow. But this is illogical. The

essential change is of a mechanical nature.

If the cervical spine could be realigned and the intervertebral spaces widened, a

normal state of blood flow would be restored. Physiotherapy can, at best, only offer

marginal relief. sometimes the condition may even be aggravated. It is better avoided.

In situations where the patient suffers acute giddiness, it is useful to restrict the

movement of the neck with a soft collar. Sudden neck movements cause the spur to

impinge on the cervical nerves and blood vessels and reduce the blood to the brain. This

creates a situation where the patient, sometimes becomes afraid of moving the neck. In

the long run, of course, a collar is to be avoided as it stiffens the neck muscles and pushes

the neck out of alignment.

The problem is worsened, as, for health, the muscles and bones have to be aligned

and stretched rather than made stiff. Cervical traction, where the skull is lifted up, has its

value in a few cases. But, in due course, the weight of the skull makes it settle down on

the cervical column and the symptoms recur. Though, obviously, the osteo-phytes cannot

be removed, one can adjust and realign the spine so that compression of the vertebral

arteries and cervical nerves does not occur.


Drug review

104

DRUG REVIEW

INGREDIENTS OF KOLAKULATHADI CHOORNA:

Kola208:

Botonical Name: Zizyphus sativus.

Family Name : Rhamnus.

Sanskrit Name : Karkandhu, Badari, Kola, Kuval, Visham.

Rasa : Amla, Madhura, Kashyaya.

Veerya : Seetha.

Vipaka : Madhura.

Guna : Guru, Snigdha, Pichila.

Doshaghnata : Vata pitta shyamak.

Botanical Description

There are three main verities namely Rajbadar, Badar, Kshudrabadar. It is a

medium sized tree with spikes. Bark-grey and thorn, Rajbadar variety is used in

medicine,

Kulatha209

Botonical Name: Dolichos biflorus Linn.

Family Name : Leguminoseae

Sanskrit Name : Kulatha, Tamrabeeja, Shweta beeja

Rasa : Kashaya

Veerya : Ushna

Vipaka : Amala

Guna : Laghu, Rooksha, Tikshna


Drug review

105

Doshaghnata : Kapha, Vata, Shyamak.

Parts used : Seeds

External uses

Powder of kulatha if applied whole body reduce excessive perspiration.

Devadaru210:

Botonical Name : Cedrus Deodara.

Family Name : Conifereae.

Sanskrit Name :

Rasa : Tiktha.

Veerya : Ushna.

Vipaka : Katu.

Guna : Laghu Snigdha.

Pradhana karma : Vedana Stapana gana.

It contains dark coloured oil and resin, internally usefull in all rukpradana vyadhis

in Aruchi and Krimi, in Raktadushya and Kaphajakasa. External uses – inflammation is

relieved by its local application, its local application and oil is used in arthritis.

Masha211 a,b

Botonical Name : Phascolus mungo

Family Name : Fabaceae.

Sanskrit Name : Uddulu, Masha.

Rasa : Madhura.

Veerya : Ushna.

Vipaka : Madhura.


Drug review

106

Guna : Guru Snigdha.

Dosha Karma : Vatashamak.

Chemical Composition

Contains Melissa oil, citrol, ionone, and vit. A.

Parts used

Roots and seeds.

Atasi212

Botonical Name : Linum Usitaissimum Linn.

Family Name : Linaceae.

Sanskrit Name : Pichila, Medaganda, Hemavati, Rudraneela.

Rasa : Madhura, Tiktha.

Veerya : Ushna.

Vipaka : Katu.


Dosha Karma : Vatashamak, Kaphapitta vardhak.


Seeds have 37 to 44% oil, white seeds have more oil, fresh oil is more viscous and

colourless but in fresh air gets solidified.

External uses

The poulitice of the flour of Atasi is used to assimilate inflammation, this external

application of its oil i.e., abhyanga in Vatashyamak.


Drug review

107

Tila213 a,b,c

Botonical Name : Sesamum indicum Linn.

Family Name : Pedalianeae.

Sanskrit Name : Tila, Homadhanya, Pavitra, Pitrutarpan.

Rasa : Madhura.

Veerya : Sheeta.

Vipaka : Madhura.


Dosha Karma : Vatashamak, Kaphapitta vardhak.


It contains oil 50-60%, Proteins 22%. It is an excellent snehan and analegesic and is very

useful for wound healing. It is very useful in dry skin and body ache by acting a

Vatashamak. Among all the varieties of taila, tila taila is considered to be the best for

nourishing all the seven dhatus of the body.

Kushtam214

Botonical Name : Saussurea luppa

Family Name : Compositae

Sanskrit Name : Padmatertha, Punyasagar, Brahnatertha

Rasa : Tikta katu madhura.

Veerya : Ushna.

Vipaka : Katu.

Guna : Laghu Rooksha, Tikshna.

Dosha Karma : Kapha vata haram.


Drug review

108


Roots contain 1.5% aromatic oil, Glucoside, Saussurinsalt, Resin, Tannin, Insulin 18%

stable oil, Nitrate, Glucose etc,. Leaves do not contain aromatic oil on incinerating, roots

yield 3.5% Ash. It contains large quantity of manganese.

Vacha215

Botonical Name : Acorus calamus Linn

Family Name : Araceae

Sanskrit Name : Ugroganda, Shadgrantha, Shataparvika

Rasa : Tikta katu.

Veerya : Ushna.

Vipaka : Katu.

Guna : Laghu, Tikshna, Sara.



Rhizome bark has 1.5 to 3.5% volatile oil which contains an asaryaldehyde. Besides, it

contains Acorine, Engenal, Asarone, Caffeine and little Astrigent.

External uses

Being analegesic and Anti inflammatory its paste is useful in Rhematoid Artharitis,

Osteoartharitis and hemiplegia.

Satahwa216a,b

Botonical Name : Anethum sawa.

Family Name : Umbeliferae.

Sanskrit Name : Shatapatrika, Shata pushpika


Drug review

109

Rasa : Katu Tikhta.

Veerya : Ushna.

Vipaka : Katu.

Guna : Laghu, Rooksha, Tikshna.



Dried ripe fruit contains a volatile oil 3-4% which is composed of anethine,

Phellanndriene, and di-limonene, Apiol, also contain carvotie and Hydrocarbone.

Yava217

Botonical Name : Trachi spermum Lini

Family Name : Umbeliferae.

Sanskrit Name : Yava

Rasa : Katu Tikhta.

Veerya : Ushna.

Vipaka : Katu.

Guna : Laghu, Rooksha.

Dosha Karma : Kapha vata haram by tikshna and ushna, pitta vardaka, used

in kapha vata disease.

Parts used : Seeds

Chemical composition

Aromatic oil is present in the seeds which solidifies on cooling and is called

thymol cyst.


Drug review

110

External uses

Being analgesis, anti-inflammatory, laxative, antibacterial, complexion enhancer

and antidote its external application reduces oedema and pain, skin diseases, scorpion

bite.

Rasna218

Botonical Name : Pluchealanceolata

Family Name : Compositeae

Sanskrit Name : Atirasa, Elaparni, Gandhanakuli

Rasa : Tikhta.

Veerya : Ushna.

Vipaka : Katu.

Guna : Guru.


Parts used : Bark

Uses:

Rheumatoid Arthitis, vata disorders, tuberculosis. It is and antipyrectic and is useful in

skin diseases like itching, ringworms, ecezema. Rasana has a specific action in

Rheumatoid arthritis.


Table No. 31 Showing the Rasa, guna, veerya, vipaka, and dosha karma of kolakulathadi choorna.

Botanical Name Family Synonyms Rasa Veerya Vipaka Guna Dosha karma Zizyphus sativus Rhamnus Badari, visham, kola Amla madhura

kashaya Sheetha Madhura Guru

snigdha pichila

Vata pitta shyamak

Dolichos biflorus Linn

Leguminoseae Kulatha Tamrabeeja Shweta beeja

Kashaya Ushna Amala Laghu Rooksha Tikshna

Kapha Vata Shyamak

Cedrus deodara Roxb.

Conifereae Devadaru Suradaru

Tiktha Ushna Katu Laghu snigdha

Vedhana stapana gana

Pluchea lanceolata

Compositae Rasna Tiktha Ushna Katu Guru Vata haram vishagnam

Phaseolous Mungo Fabaceae Uddulu Masha

Madhura Ushna Madhura Guru snigdha

Vata shaman

Linum usitassimum Linn.

Linaceae Medagnda Hemavati Atasi

Madhura Tiktha

Ushna Katu Guru snigdha

Vata shamak kapha pitta vardak

Sesamum indicum Linn.

Pedalianeae Tila Homadhanya Pavitra

Madhura Sheetha Madhura Guru snigdha

Vata shamak kapha pitta vardak

Saussurea luppa Compositae Padmatertha Punyasagar Brahnatertha

Tiktha Katu Madhura

Ushna Katu Laghu Rooksha Tikshna

Vata kapha haram

Acorus calamus Linn

Araceae Ugroganda Shadgrantha Shataparvika

Tiktha Katu

Ushna Katu Laghu Tikshna Sara

Kapha Vata Haram

Anethum sawa Umbeliferae Shatapatrika Shata pushpika

Katu Tiktha

Ushna Katu Laghu Rooksha Tikshna

Kapha Vata Haram

Trachi spermum Lini

Umbellifere Yava Katu Tikta Ushna Katu Rooksha Laghu

Kapha vata shamaka

Table no. 32. Showing the Table of Mahamasha taila

Sl.No

Name Latin Name Rasa Guna Veerya Vipaka Parts used Doshaghnata Karmukata

1 Bilwa219 Aele Marmeolos corr

Katu, Tikta, Kashaya

Laghu Rooksha

Ushna Katu Moola Vatakapha Shamaka pitta Vardhaka

Deepana pachana, Grahi, balya

2 Agnimantha220 Premna mucronuta

Tikta, katu, kashaya, madhura

Rooksha laghu

Ushna Katu Moola Kaphavata Shamaka

Deepana, pachana, Vedana Shamaka, Anulomaka

3 Shyonaka221 Oroxylum indicum

Madhura, Tikta Kashaya

Laghu Rooksha

Ushna Katu Moola Khapavata Shamaka

Shothahara, Vedhana, Shamaka, Deepaka, Pachaka, Rochaka.

4 Patala222 Stereospermum Surveolens

Tikta, Kashaya

Laghu Rooksha

Ushna Katu Moola Tridosha Shamaka

Vedana Shamaka, Shotahara, Deepaka, Pachaka, Rochak

5 Kashmarya223 Gmelinza arborex

Tikta, Kashaya, Madhura

Guru Ushna Katu Moola Tridosha Shamaka

Anulomaka, Shothara, Vrishya, Balya.

6 Shalaparni224 Desmodium ganqeticum

Madhura, Tikta

Guru Snigdha

Ushna Madhura Moola Tridosha Shamaka

Shotahara, Anulomana.Virshya.

7 Prsniparni225 Uraria picta Madhura, Tikta

Laghu Singdha

Ushna Madhura Moola Tridosha Shamaka

Vedana Shamaka, Shotahara

8 Brahathi226 Solanum indicum

Katu, Tikta

Laghu Rooksha, Teekshna



9 Kantakari227 Solanum surateense burn

Tikta, Katu

Laghu Rooksha, Teekshna



10 Gokshura228 Tribulus terristris

Madhura Guru, Snigdha

Sheeta Madhura Moola Vatapitta Shamaka

Vedana Shamaka, Anulomana, Shothara

11 Masha229 Phaseotus mungo leguminosal

Guru srigdha

Madhura Ushna Madhura Phala beeja Vatashamak pitta & kapha vardhaku

Vatayadhi, sandivata nadidourbalya

12 Kapikachu231 (atmaguptha)

Muchuna prurita leguminosae

Guru srigda

Madhura tikta

Ushna Madhura Beeja moola roma

Tridoshagna Vatavyadhi, nadidourbalya krisha

13 Shati232 Hedychium spicatium zingiberaceae

Laghu thikshna

Katu Tikta Kashaya

Ushna Katu Kandha Kaphavatagna Vedanasthapana, Shoolaprashamana deepana grahi

14 Devadaru Cedriusdeodarapinaceae

Laghu snigdha

Tikta Ushna Katu Kandasara Taila

Kaphavatagna Shothavedanapradhana rogas sandivasa etc. vatavyadhya

15 Bala Sida cordifolia Madura Laghu, snigdha

Picchila Madhura Moola Vata pitta hara

Balya, Bramhana, Vrshya

16 Rasna233 Pluchea lanceolata compositae

Guru Tikta Ushna Katu Patra Kaphavatagna Vednashamaka, shothaX shoolapradhana vikras, sandishoola

17 Prasarini Leptadenia sperlum Asclepiadacea

Guru Tikta Kashaya

Guru sara

Katu Moola Vata kapha Shamaka

Vedanasthapana, Shoolaprashamana deepana grahi

18 Kushta Saussurealappa compositae

Laghu rooksha tikshna

Tikta katu madhura

Ushna Katu Moola Kaphavatagna Shoolaprashamana, vedanasthapana, deepana, pachana

19 Parushaka Grewia asiatica Madhura, Amla, Kashaya

Laghu, Snigdha

Sheeta Katu Vata pitta shamaka

Vatavyadhi, vedanapradhana vikaras, nadidourbalya

20 Bharangi Uerodendrum serratum

Tikta katu Laghu Rooksha

Ushna Katu Moola Vata kapha shamaka

Vatahara, Shothahara,

21 Punarnava234 Boerhavia diffusa

Madhura tikta

Laghu Rooksha

Ushna Madhura Moola Vayasthaapana, vata kaphara

Rasayana, vishagna, Kasahara

22 Mathulunga Litrus acido medica

Madhura, Amla

Laghu snigdha

Anushna Madhura Tvak Vata, pitta, kapha hara

Vata, pitta, kapha hara, hrydhya

23 Jeeraka235 Cuminum cuminumcyminum Umbeliferacea

Katu Laghu Rooksha

Ushna Katu Beeja Kaphavatanga vatahara, Pittavardhaka

Deepaka, pachaka

24 Hingu Ferula narthex Katu Laghu snigdha

Ushna Katu Niriyasa Kapha, Vata shamaka

Shula prashamana, deepana, Vajikarna

25 Shatavari236 Asparagu racimosum

Tikta Madhura

Guru, snigdha

Sheeta Madhura Kanda Tridosha shamaka

Vedanasthapaka, Shulahara

26 Goksura237 Tribulus terrestris zygophyllaceae

Guru snigdha

Madhura Sheetha Madhura Phara moola Vatapittagna Vatavyadhi, vedanapradhana vikaras, nadidourbalya

27 Pippali Moola238

Piperlongum piperaceae

Laghu Snigdha Tikshna

Katu Anushna sheeta

Madhura Phalamoola Kaphavatagna Shotha, vatayadhi, aruchi, ajeerna

28 Chitraka239 Plumbago zeylamica plumbaginaceae

Laghu Rooksha Tikshna

Katu Ushna Katu Moolatwak Kaphavatagna Vatavyadhi nadidourbalya deepana pachana

29 Mudgaparni240 Phaseolus Trilobus (leguminosae)

Lagu Rooksha

Madhura Tikta

Sheetha Madhura Panchangamoola

Vatapittagna Vatahara, roga, deepana and grahi

30 Mashaparni241 Teramnuslabialis Leguminosae

Laghu Snigdha

Madhura Tikta

Sheetha Madhura Panchangamoola

Vatapittagna Vatanulomana, snehana, deepana, shothahara

31 Jeevanthi242 Leptadenia Reticulata Asclepiadaecae

Laghu snigdha

Madhura Sheetha Madhura Panchangamoola

Vatapittagna Snehana, anulomana, grahibalya, rasayana

32 Madhuka243 Glycyrhiza Glabra leguminosae

Guru snigdha

Madhura Sheetha Madhura Panchangamoola

Vatapittagna Vatanulomana, nadidourbalya

33 Saindhava lavana

Rock salt

Madhura, Lavana

Sheeta

Madhura Laghu, Snigdha, Sukshma

- Tridosha Shamaka

Deepana,Pachana,Rechana,Ruchikara, Hridya, Chakshushya

34 Ksheera (Cow’s milk) 229

Madhura Sheeta Madhura Guru Snigdha, sheetha

Tridosha Shamaka

Brimhanam, Vrishya, Balya, Vata roga, Swasa and Kasa

35 Tila thaila230 Sesamum indicum

Madhura katu tiktha

Ushana Madhura Guru Seeds Vata nashaka Vata vyadhi, Medoroga, Vrana, shotha

Clinical study

116

CLINICAL STUDY

Methodological approach is the backbone of research. Utmost care is

taken in designing a methodology for conducting a research. Clinical research involves

the experimentation of a drug/therapy on a population and recording the feedback based

on which postulations are made regarding the usefulness of the drug/therapy in the

disease. Hence, in this section, the researchers put forward the systemic procedures,

which are followed by the researchers right from the identification of the problem to the

final conclusion.

Research Approach

In this clinical study, the objective was to “evaluate the efficacy of

Rookshasweda and Nasya in the management of Manyasthamba (Cervical

spondylitis)”. The efficacy of this was determined by finding of base line data of the

parameters before and after the treatment data was compared with only Rookshasweda to

study the added effect of Nasya karma.

Study Design

It is a comparative clinical study. Total patients were made in to two Groups A

and B. Group A will receive only ruksha sweda and Group B will receive Rooksha sweda

with nasya karma.

Source of Data

Patients suffering from Manyasthambha will be selected from Dept. of

Panchakarma P.G.S. & R (Panchakarma) O.P.D. & I.P.D. of Shri D..G. Melmalgi

Ayurvedic College Hospital.


Clinical study

117

Sample Size & Grouping

A minimum of 30 Patients equally distributed in each groups.

Group A - Rooksha sweda with Kolakulathadi choorna pinda around the cervical region

and shoulders.

Group B – Local Rooksha sweda with Kolakulathadi choorna pinda around the cervical

region and shoulders followed by Nasya with Mahamasha thaila.

Selection criteria

The cases were selected strictly as per the pre-set inclusion and exclusion of

criteria.

Inclusion Criteria

• All cases of clinical and radiological evidence of Manyastambha (Cervical

spondylitis)

• Without any discrimination of chronicity and severity of the diseases.

• Patients of both sex

• Patients of Manysthambha falling in the age group of 18-65 years.

• Patients fit for Nasya karma.

Exclusion Criteria

• Patients below 15 and above 65 years of the age.

• Preganant women and lactating Mothers.

• Any other systemic disorders other than of Manyasthambha.

• Any other degenerative diseases associated.

• Patients unfits for Nasya karma


Clinical study

118

Duration of the study

In both groups, initially 7 days of treatment followed by 7 days of rest. Then,

treatment repeated for 7 days again followed by 7 days of rest. The total study duration is

28 days.

Data Collection

Patients were thoroughly examined both subjectively and objectively. Detailed

history pertaining to the mode of onset, previous ailment, previous treatment history,

family history, habits, ashtavidhapareeksha and dashavidhapareeksha and physical

examination findings were noted. Routine investigations were done to exclude other

pathologies. Radiological features also were investigated.


Clinical study

119

Examination

History




extremity. The brachial plexus is affected. The trapezius area becomes tender and painful.

A nodule can form in the muscle due to chronic pressure. The symptoms of cervical cord

compression can sometimes be severe. The pain radiates down the right or left arm to the

fingers, to the chest and shoulder blades depending on which side the nerve root is

involved. It can become continuous, making movements painful and limited. If the

cervical vertebrae become unstable, the danger of cord compression is imminent and, in

some cases, fusion of the bones may be warranted. But this is rare.

Examination of the Cervical spine

This is always associated with a dearth of objective findings. Physical

examination includes.

1. Inspection

2. Palpation

3. Movements

1) Inspection

Although the deformity of the cervical spine is unusual in cervical spondylitis is

always at the head on the neck as a whole before palpating assessing the movements.

Patient with cervical spondylitis for eg:- They may have a pokeneck. Check also that the


Clinical study

120

patient can support the head without difficulty instability of the cervical spondylitis can

be easily missed in recumbency position.

2) Palpation

Midline, tenderness over the supra spinous ligament is found after an injury to the

neck such as sprain / whiplash injury. Tenderness and spasm of the paraspinal muscles

extending down to the trapezius are found in cervical spondylitis.

3) Movements

The neck movements includes flexion, extension, lateral rotation, and lateral

flexion. Neurological examination is normal provided the disease cervical spondylitis not

associated with complaints.

Types of Pain

Patient experiences different types of pain depending on underlined pathology

1. Aching type of pain

2. Grippling pain

3. Vague, ill defined and ill localized pain

4. Throbbing pain

5. Shooting pain

6. Pricking pain

The neck pain may be chronic or episodic, with long period of remission. Usually

pain is more frequent in the upper limb then in the neck, although it is present

frequently in both the areas. A case of cervical spondylitis may exactly mimic the

cardiac pain by radiating the left arm and chest so if a patient is a known case of


Clinical study

121

cervical spondylitis, when he gets a real heart attack, pain is attributed to spondylitis,

and the diagnosis is missed.

Mobility grading of Cervical spine

Flexion

Is examined by asking the patient to touch the chin to chest full forward flexion is

present. When the chin touches the chest. It is graded as four. If the flexion is 75% of

total movement then it is graded as three. 50% of the movement is graded as two. 25% of

total movement is graded as one and no movements is graded as zero.

Extension

Of at least 30 degrees beyond the horizontal is only possible.

It is graded as four it the extension is 75 degree of total movement then it is graded as

three. 50 degree of the movement is graded as two. 25 degree of movement is one and

zero as no movement.

Lateral flexion

Lateral flexion should be at least 40 degree to each side. Starting from the neutral

position of the head is tilted first to one side and then the other. Grading is done on

above.

Rotation

Cervical plexus

The cervical plexus is formed by the vertebral rami of the upper four cervical

nervous. The rami emerge between the anterior and posterior tubercles of the cervical

transverse processes, grooving the costo transverse bars. The four roots are with one

another to form three loops.


Clinical study

122

The plexus is related posteriorly to the muscles, which arise from the posterior

tubercles of the transverse process i.e., the Levator scapulae and the scanlenus medius.

Anteriorly to the pre-vertebral facia, the interior jugular vein and sterno mastoid.

Branches

A) Superficial cutaneous branches

1. Lesser occipital

2. Greater auricular

3. Transverse (anterior) cutaneous nerve of the neck (c2,c3)

4. Supra clavicular (c3,c4)

B) Deep branches

1. Communicating branches

2. Muscular branches

(a) rectus capitis anterior from c1

(b) rectus captis lateratus from c1,c2

(c) longus capitis from c1,c2,c3

(d) lower root of anasa cervicalis c2c3

Muscles supplied by cervical branches

1. Stermomastoid – c2 and accessory nerve

2. Trapezius – c3-c4

3. Lavetor scapularis – c3c4c5

4. Phrenic nerve c3c4c5

5. Longus colli c3-8

6. Scalenus medius c3-8

7. Scalenus anterior c4-6

8. Scalenus posterior c6-8


Clinical study

123

Treatment Schedule

Group A – Rookshaswedam with Kolakulathadi choorna pinda.

Ingredients

Kola, Kulatha, Devadaru, Rasna, Masha, Atasi, Tila, Vacha, Satahwa, Yava.

Preparation

Medicine Kolakulathadi choorna, the above said ingredients were taken in raw

form after removing the impurities. There then individually were pulverized to get fine

powder after obtaining the fine powder they were mixed to get uniform mixture.

Pottali

2 Pottali were prepared each containing 200 gms of Kolakulathadi choorna they

were tied properly and kept for ready for the treatment .

Patient

Patient were selected after fulfilling the criterias. The patient were briefed about

the intended procedure. Patients were asked to sit comfortably over a stool of knee

height.

Procedure

Two pottalis were heated up to a sustainable heat and were used alternatively to

give the swedana over the cervical region and on both shoulders. This procedure is done

by pressing, rubbing & keeping over the said body parts. The whole procedure was

repeated for about 15-20 min depending on the response of the individual patient.

Paschat Karma

Patient is asked to rest for 15-20 minutes in the comfortable position.


Clinical study

124

Pathya during treatment period & pariharakala

The pathyacharana is an important factor which was followed for 28days

including the treatment period & pathyacharana. Patients were advised to take katu-

tiktha-kashaya-rooksha varjitha aharadravyas in light quantity. Rice gruel with little milk

was advised as the ideal food. Patient was advised to drink hot water only. Patient was

advised to avoid sexual intercourse, blocking of natural urges, traveling, exercise, over-

speech, uneven sitting & lying postures, exposure to wind, cold, heat and dust, anger and

grief.

Group B- Rookshasweda along with Nasya

1) Rookshasweda

Is performed as explained before.

2) Method of preparation of Mahamasha thaila

Masha and dasamula are prepared in to yavakuta curna and dissolved in

mentioned quantity of water in a kashaya patra and kept as it is for one night and next day

these contents are reduced into 1/4th quantity over madhyamagni according to kwatha

vidhi. Kwatha is filtered and kept ready.. Murchita tila taila is taken in a sneha patra and

heated over madhyamagni then already prepared kwatha is added and mixed well, after

that cows –milk is added. While adding kwatha etc. dravadravyas. Kalka of above

mentioned drugs are to be added and mixed well, then taila is prepared according to

tailapaka vidhi. After attaining paka pariksa, sneha patra has to be taken out from the fire

& taila is filtered immediately and obtained taila is preserved.


Clinical study

125

3) Nasya

Special room for Nasya should be prepared which should be free from

atmospheric effects like direct blow of air or dust and it should be lighted properly.

a) A chair for sitting purpose

b) A cot for lying purpose

To prepare the patient for the Nasya karma following matter should be considered

Patient should have passed his natural urges like urine and stool.

He should have completed his routine activities.

Light breakfast prior (1 hour) to Nasya karma is advised.

After preparation of patient by above said regimens, snehana and swedana should

be done. Here, Snehana means, Mridu Abhyanga. It should be done on scalp, forehead

and neck for 3 to 5 minutes by medicated oil like Bala taila etc.

After Abhyanga, Mrudu Swedana should be done on Shira, Mukha, Nasa, Manya,

Greeva and Kantha. Swedana should not be done on the head, but for the purpose of

elimination and liquification of dosha Mridu Swedana can be done as Purva karma of

Nasya.

Pradhana Karma

Posture of The Patient :

Patient should lye down in supine position on Nasya table. The head of the patient

should be lowered (Pravilambita). The position of head should not be excessively

extended. After covering of eyes with a clean cloth, the tip of patients nose should be

drawn upward by the left thumb of the Vaidya. At the same time with the right hand

Vaidya should instill 8 drop of lukewarm oil (Mahamasha Taila) in both the nostrils,


Clinical study

126

alternately, with the help of proper instrument like pichu, dropper, The drug should be

proper in dose and temperature. The patients should remain relaxed at the time of

administration of nasya and he should avoid speech, anger, sneezing, laughing and

shaking his head.

Pashchat Karma

Patient in lying position is asked to count up to 100 matra i.e. approximately 2

minutes. After administration of Nasya feet, shoulders, palms and ears should be

massaged. Again mild fomentation should be done on forehead, cheeks and neck. For

pacifying Vata dosha, Rasna churna is rubbed on head. The patient is asked to expel out

the drug which comes in oropharynx. Care should be taken that no portion of medicated

oil is left behind. Medicated Dhumpana and Gandusha are advocated to expel out the

residue mucous lodged in Kanta.

Pathya during treatment period & pariharakala

Patient should be advised to stay in a windless place. A light meal and lukewarm

water are advised. One should avoid dust, smoke, sunshine, hot bath, anger, riding,

excessive intake fat and liquid diet the patient should avoid day sleep and should not use

cold water for any purpose like pana, snana, etc.


Clinical study

127

Methods of Assessment of clinical response

Clinical parameters and functional parameters, were made out to assess the

clinical response in both the groups.

I. Subjective

(Ruk) Pain 0 – No pain

1 mild – pain present positionally does not require

Medications

2 Moderate - Pain present irrespective of posture

relieves by hot fomentation

3 M severe - Pain present relives by oral medication.

4 severe - Pain does not relived by medication

present persistently.

II. Graha

(Stiffness) Grade 0 - No movement

Grade 1 - Up to 25% of total movement

Grade 2 - Up to 50% of total movement

Grade 3 - Up to 75% of movement

Grade 4 - Full range.

Objective

Mobility (Flexion) Grade 0 - No movement

Grade 1 - Restricted movement

Grade 2 - Full range


Clinical study

128

Extension Grade 0 - No movement



Lateral flexion Grade 0 - No movement



Rotation Grade 0 - No movement



Passive neck flexion Grade 0 - With any difficulty

Grade 1 - With some difficulty

Grade 2 - With much difficulty

Grade 3 - Unable to do

Muscle strength

Grade 0 - Complete paralysis

Grade 1 - A flicker of contraction

Grade 2 - Power detectable only when gravity is

excluded by appropriate postural

adjustment.

Grade 3 - The limp can be held in the force of gravity

but not the examiners resistance.

Grade 4 - There is some degree of weakness, usually

described as poor, severe or moderate

strength.


Clinical study

129

Assessment of Nasyakarmukatha

This was done to ascertain the efficacy of Nasya karmas in inducing the

benefits of Nasya in the group B. the following parameters were designed basing on the

samyak Nasya lakshana explained by vagbhatta.

Sukhouchvasam Grade 0 - No change

Grade 1 - Slight improvement.

Grade 2 - Marked improvement.

Sukhaswapnam Grade 0 - No change



Sukhabodha Grade 0 - No change



Akshipadavam Grade 0 - No change



Assessment Of Swedakarmukatha

This was done to ascertain the efficacy of both the Karmas in inducing the

benefits of Swedana in the individual groups. The following parameters were designed

basing on the Shamana-Sweda gunas explained by Sushrutha.

• Agnideepti :- Grade 0 – No change/Absent

Grade 1 – Slight improvement/Present

Grade 2 – Good improvement


Clinical study

130

• Maardava :- Grade 0 – No change/Absent



• Tvakprasada :- Grade 0 – No change/Absent



• Tandrahaani :- Grade 0 – Absent

Grade 1 – Present

• Bhakthasradha :- Grade 0 – Absent

Grade 1 – Present

• Sandhicheshta :- Grade 0 – No movement

Grade 1 –Up to 50% of the full range of joint

motion

Grade 2 – 50-75% of the full range of joint

motion

Grade 3 – >75% & <full range

Grade 4 – Full Range of joint Motion

• Srothonirmalatva :- Grade 1 – Very satisfied

Grade 2 – Somewhat Satisfied

Grade 3 – Neither satisfied nor dissatisfied

Grade 4 – Somewhat dissatisfied

Grade 5 – Very dissatisfied


Clinical study

131

Overall Assessment Of Clinical Response

• Good Response : >60% improvement in clinical and functional

parameters

• Moderate Response : 31-60% improvement in clinical and functional

parameters

• Poor Response : 1-30% improvement in clinical and functional

parameters

• No Response : 0 % or No improvement in clinical and functional

parameters


Observation and Results

132

33 patients were registered for the present study. Out of this, 3 patients were

excluded hence, their data has not been included here. The remaining 30 patients of

Manyasthamba fulfilling the criteria for diagnosis, were treated in the following two

groups –

Group A – Rooksha sweda – 15 patients.

Group B – Rooksha sweda and Nasya – 15 patients.

All the patients were examined before and after the treatment according to the

case sheet format given in the appendix. Both the subjective and objective changes were

recorded along with the assessment of Nasyakarmukata and Swedakaarmukata. The data

recorded are presented under the following heading –

1) Demographic data

2) Data related to the disease

3) Data related to over all response to the treatment

4) Statistical analysis of the clinical and functional parameters and inter group

comparison.

5) Statistical analysis of Nasyakarmukata

6) Statistical analysis of swedakarmukata



133

I. DEMOGRAPHIC DATA

Table No. 33. Showing distributions of patients by age Groups.

Age Group Group A % Group B % Total Total % 21-30 3 20% 1 6.66% 4 13.33% 31-40 6 40% 4 26.66% 10 33.33% 41-50 4 26.66% 4 26.66% 8 26.66% 51-60 1 6.66% 5 33.33% 6 20% 61-70 1 6.66% 1 6.66% 2 6.66%

Among the 15 patients in the group A maximum number of patients fell in the age

group 31-40 i.e. 6 patients (40%), where as 4 patients (26.66%) fell in the age group 41-

50 and only 3 patient (20%) fell in the age group 21-30. and 60-70 one patient (6.66%)

and only one patient fell in the age group 51-60 Among the 15 patients in the group B,

maximum number of patients, fell in the age group 51-60 i.e 5. (33.33%) where as 4

patients (26.66%) fell in the age group 31-40. 4 patients (26.66%) fell in the age group

41-50. 1 patient (6.66%) fell in the age group 21-30 (6.66%) 1 patient fell in the age

group 61-70 (6.66%) In the study as a whole (30 patients), maximum numbers of

patients, fell in the age group 31-40 i.e. 10 (33.33%), where as 8 patients (26.66%) fell in

the age group 41-50 and 6 patient fell in the age group 51-60 (20%) and 4 patients fell in

the age group 21-30 (13.33%) and 2 patients fell in the age group 61-70 (6.66%)

Showing distributions of patients by age Groups.

31

46

4

10

4 4

8

1

56

1 12

02468

1012

Group A Group B Total

21-3031-4041-5051-6061-70



134

Table No. 34 Showing distributions of patients by sex

Sex Group A % Group B % Total %

Male 10 66.66% 9 60% 19 63.33%

Female 5 33.33% 6 40% 11 36.66%

Among the 15 patients in the group A, 10 patients were males (66.66%) and 5

patients were females (33.33%). Among the 15 patients in the group B, 9 patients were

males (60%) and 6 patients were females (40%). In the study as a whole (30 patients), 19

patients were males (63.66%) and 11 patients were females (36.33 %).

10

5

96

19

11

0

5

10

15

20

Group-A Group-B Total

Showing the incidence of sex

Male

Female



135

Table No.35 Showing distributions of patients by Religion

Religion Group A % Group B % Total %

Hindu 12 80% 12 80% 24 80%

Muslim 3 20% 3 20% 6 20%

Christian 0 0% 0 0% 0 0%

Among the 15 patients in group A, 12 patients were Hindus (80%), 3 patients

were Muslims (20%). Among the 15 patients in group B, 12 patients were Hindus (80%)

and 3 patients were Muslims (20%). In the study as a whole (30 patients), 24 patients

were Hindus (80%), 6 patients were Muslims (20%).

Showing distributions of patients by Religion

12 12

24

3 36

0 0 00

5

10

15

20

25

30


HinduMuslimChristian



136

Table No.36 Showing distributions of patients by Occupation

Occupation Group A % Group B % Total %

Sedentary 2 13.33% 7 46.66% 9 30%

Active 7 46.66% 6 40.00% 13 43.33%

Labour 6 40.10% 2 13.33% 8 26.66%

Others 0 0% 0 0% 0 0%

Among the 15 patients in the group A, 2 patients (13.33%) were of sedentary, 7

patients (46.66%) were active and 6 patients (40.10%) were labours. Among the 15

patients in the Group B, 7 patients (46.66%) were sedentary, 6 patients (40%) were active

and 2 patients (13.33%) were labours. In the study as a whole (30 Patients), 9 patients

(30%) were sedentary, 13 patients (43.33%) were active and 8 patients (26.66%) were

labours.

Showing distributions of patients by Occupation

2

79

76

13

6

2

8

0 0 002468

101214


SedentaryActive LabourOthers



137

Table No.37 Showing distributions of patients by Economical status

Economical

status

Group A % Group B % Total %

Poor 1 6.66% 1 6.66% 2 6.66%

Lower

middle

7 46.66% 6 40.00% 13 43.33%

Upper

middle

5 33.33% 8 53.33% 13 43.33%

Rich 2 13.33% 0 0% 2 6.66%

Among the 15 patients in group A, 1 patient were poor (6.66%), 7 patients were

of the Lower middle class (46.66%) and 5 patients were Upper middle (33.33%). and 2

patients were rich (13.33%) Among the 15 patients in the group B, 1 patients were poor

(6.66%), 6 patients were of Lower middle class (40 %) and 8 patient was Upper middle

class (53.33%). In the study as a whole (30 Patients), 2 patients were poor (6.66%), 13

patients were of the lower middle class (43.33%) and 13 patients were upper middle class

(43.33%). 2 patients were rich (6.66%).

Showing distributions of patients by Economical status

1 12

76

13

5

8

13

20

2

02468

101214


PoorLower middleUpper middleRich



138

Table No. 38 Showing distributions of patients Dietary habit

Dietary

habit


Vegetarian 3 20% 5 33.33% 8 26.66%

Mixed 12 80% 10 66.66% 22 73.33%

Among the 15 patients in group A, 3 patients were vegetarians (20%) and 12

patients were having mixed dietary habits (80%). Among the 15 patients in group B, 5

patients were vegetarians (33.33%) and 22 patients were having mixed dietary habits

(73.33%). In this study as a whole (30 patients), 8 patients were vegetarians (26.66%) and

22 patients were having mixed dietary habits (73.33%).

Showing distributions of patients Dietary habit

35

8

1210

22

0

5

10

15

20

25


VegetarianMixed



139

Table No. 39 Showing distributions of patients by Agni

Agni Group A % Group B % Total %

Manda 8 53.33% 7 46.66% 15 50%

Teekshna - - - - - -

Vishama 3 20% 5 33.33% 8 26.66%

Sama 4 26.66% 3 20% 7 23.33%

Among the 15 patients in group A, 8 patients were having Manda agni (53.33%),

3 patients were having vishama agni (20%) and 4 patients were having sama agni (20%).

Among the 15 patients in group B, 7 patients were having Manda agni (46.66%), 5

patients were having vishama agni (33.33%) and 3 patients were having sama agni

(20%). In the study as a whole, 15 patients were having manda agni (50%). 8 patients

were having vishama agni (33.33%) and 7 patients were having sama agni (23.33%). No

patients reported with Teekshna agni in this study.

Showing distributions of patients by Agni

8 7

15

0 0 0

35

8

4 3

7

02468

10121416


MandaTeekshnaVishamaSama



140

Table No. 40 Showing distributions of patients by Koshta

Koshta Group A % Group B % Total %

Madhya 9 60% 11 73.33% 19 63.33%

Mrdu 1 6.66% 1 6.66% 2 6.66%

Krura 5 33.33% 3 20% 8 26.66%

Among the 15 patients in group A, 9 patients were having Madhya koshta (60%),

1 patient was having Mridu koshta (6.66%) and 5 patients were having Krura koshta

(33.33%). Among the 15 patients in group B, 11 patients were having Madhya koshta

(73.33%), one patient was having Mridu koshta (6.66%) and 3 patients were having

Krura koshta (20%). In the study as a whole (30 patients), 19 patients were having

Madhya koshta (63.33%), 2 patients were having Mridu koshta (6.66%), and 8 patients

were having Krura koshta (26.66%).

Showing distributions of patients by Koshta

911

19

1 1 25

3

8

0

5

10

15

20


MadhyaMrduKrura



141

Table No.41 Showing distributions of patients by Nidra

Nidra Group A % Group B % Total %

Sukha 2 13.33% 2 13.33% 4 26.66%

Alpa 5 33.33% 8 53.33% 13 43.33%

Ati 2 13.33% 2 13.33% 4 13.33%

Vishama 6 40.00% 3 20% 9 30%

Among the 15 patients in group A, 5 patients had alpa nidra (33.33%) and 6

patients had vishama nidra (40%). 2 patients had sukha nidra (13.33%) and 2 patients had

alpa nidra (33.33%) Among the 15 patients in group B, 8 patients had alpa nidra

(53.33%), 2 patient had ati nidra (13.33%) and 3 patients had vishama nidra (20%). 2

patients had sukha nidra (13.33%) In the study as a whole (30 patients), 13 patients had

alpa nidra (43.33%), 4 patients had ati nidra (13.33%) and 9 patients had vishana nidra

(30%). 4 patients had sukha nidra. (26.66%).

Showing distributions of patients by Nidra

2 24

5

8

13

2 24

6

3

9

02468

101214

Group A Gruoup B Total

SukhaAlpaAtiVishama



142

Table No. 42 Showing distributions of patients by Vyasana

Vyasana Group A % Group B % Total %

Smoking 3 20% 1 6.66% 4 13.33%

Tobacco 8 53.33% 9 60% 17 56.66%

Alcohol 3 20% 4 26.66% 7 23.33%

Others - 0% - - -

None 1 6.66% 1 6.66% 2 6.66%

Among the 15 Patients in group A, 3 patients had smoking habit (20%), 8 patients

had tobacco habit (53.33%), 3 patients had alcohol habit (20%) and 1 patient had no

habits (6.66%). Among the 15 patients in group B, 1 patient had smoking habit (6.66%),

9 patients had tobacco habit (60%), 4 patients had alcohol habit (26.66%) and 1 patients

had no habits (6.66%). In the study as a whole, 4 patients had smoking habit (13.33%),

17 patients had tobacco habit (56.66%), 7 patients had alcohol habit (23.33%) and 2

patients had no habits (6.66%). No patient reported in this study had any other habits.

Showing distributions of patients by Vyasana

31

14

8 9

17

3 47

0 0 01 1 2

0

5

10

15

20


SmokingTobaccoAlcoholOthersNone



143

Table No.43 Showing distributions of patients by Deha-prakriti

Deha Prakriti Group A % Group B % Total %

Vata pitta 7 46.66% 8 60% 15 50%

Vata kapha 5 33.33% 4 26.66% 9 30%

Pitta kapha 3 20% 3 20% 6 20%

Among the 15 patients in group A, 7 patients were of Vata pitta prakriti (46.66%),

5 patient of Vata Kapha prakriti (33.33 %), 3 patients of Pitta Kapha (20%), Among the

15 patients in group B, 8 patients were of Vata Pitta prakriti (60%), 4 patients of Vata

kapha prakriti (26.66%), 3 patients of Pitta kapha (20%). In the study as a whole (30

patients), 15 patients were of Vata pitta prakriti (50%), 30 patient of Vata Kapha prakriti

(30%), 6 patients of Pitta kapha prakriti (20%).

Showing distributions of patients by Deha-prakriti

78

15

54

9

3 3

6

02468

10121416


Vata pittaVata kaphaPitta kapha



144

Table No.44 Showing distributions of patients by Satmya

Satmya Group A % Group B % Total %

Rooksha 13 86.66% 15 100% 28 93.33%

Snigdha 2 13.33% - - 2 6.66%

Among the 15 patients in group A, 13 patients were of rooksha satmya (86.66%)

and 2 patients were of snigdha satmya (13.33%). All the patients of group B, were of

rooksha satmya. In the study as a whole (30 patients), 28 patients were of rooksha satmya

(6.66%) and 2 patients were of snigdha satmya.

Showing distributions of patients by Satmya

1315

28

20

2

0

5

10

15

20

25

30


RookshaSnigdha



145

Table No.45 Showing distributions of patients according to chronicity of the disease.

Duration Group A % Group B % Total %

Less than 6 3 20% 2 13.33% 5 16.66%

6M – 1yr 8 53.33% 6 40% 14 46.66%

1–11/2 yrs 4 26.66% 7 46.66% 11 36.66%

Among 15 patients in group A, 3 patients falls under below 6 months (20%) 8

patients falls under 6M – 1 year (53.33%) 4 patients falls under 1yrs-11/2 yrs (26.66%)

among 15 patients in group B, 2 patients falls under below 6 months (13.33%) 6 patients

falls under 6M – 1 yrs (40%) 7 patients falls under 1yrs-11/2 yrs (46.66%) In the study as

a whole (30 patients) 5 patients falls under below 6 months (16.66%) 14 patients falls

under 6M-1yrs (46.66%) 11 patients falls under 1yrs-11/2 yrs (36.66%).

Showing distributions of patients according to chronicity of the disease.

3 2

5

86

14

4

7

11

02468

10121416


Less than 66M - 1yr1- 11/2yr



146

Table No.46 Showing distributions of patients by Ahara Nidana:

Rasa Group A % Group B % Total % Katu Rasa 5 33.33% 6 40% 11 36.66% Tikta Rasa 1 6.66% 1 6.66% 2 13.33% Kasaya Rasa 1 6.66% 1 6.66% 2 13.33% Ati sheeta 3 20% 2 13.33% 5 16.33% Ati Rooksha 4 26.66% 5 33.33% 9 30.00% Alpa ahara 1 6.66% - 1 6.66%

Among 15 patients in group A, 1 patients had tikta rasa atisevana (6.66%), 1

patients had kashaya rasa atisevana (6.66%), 5 patients had katu rasa atisevana (33.33%),

1 patients had alpa bhojana (6.66%), 3 patients had Ati sheeta bhojana (20%) and 4

patients had rooksha bhojana (26.66%). Among 15 patients in group B, 1 patient had

tikta rasa atisevana (6.66%), 1 patients had kashaya rasa atisevana (6.66%), 6 patients

had katu rasa atisevana (40%), 2 patients had Ati sheeta bhojana (13.33%), 5 patients had

rooksha bhojana (33.33%). In the study as a whole (30 patients), 2 patients had tikta rasa

atisevana (13.33%), 2 patients had kashaya rasa atisevana (13.33%), 11 patients had katu

rasa atisevana (36.66%), 1 patients had alpa bhojana (6.66%), 5 patients had Ati sheeta

bhojana (30%) and 9 patients had rooksha bhojana (30%).

Showing distributions of patients by Ahara Nidana

56

11

1 12

1 12

32

54

5

9

10

1

02468

1012


Katu RasaTikta RasaKasaya RasaAti sheetaAti RookshaAlpa ahara



147

Table No. 47 Showing distributions of patients by Vihara Nidana:

Vihara GroupA % GroupB % Total % Asamasthana syanam

4 26.66% 5 33.33% 9 30.33%

Urdwa Nireekshanam

4 26.66% 1 6.66% 5 16.66%

Diva swapnam 3 20% 1 6.66% 4 13.33% Vyayama 3 20% 3 20% 6 20% Langhana - - - - - - Plavana - - - - - - Adwaganama 2 13.33 2 13.33 4 13.33 Yana - - 2 13.33% 2 6.66%

Among 15 patients in group A, 4 patients had Asamasthana syanam (26.66%), 4

patients had Urdwa Nireekshanam (26.66%), 3 patients had Diva swapnam (20%), 3

patients had Vyayama (20%), 2 patients had Adwaganama (13.33%) and No patients

were absorbed having Langhana, Plavana and Yana. Among 15 patients in group B, 5

patient had Asamasthana syanam (33.33%), 1 patients had Urdwa Nireekshanam

(6.66%), 1 patients had Diva swapnam (6.66%), 2 patients had Adwaganama (13.33%), 2

patients had Yana (13.33%). No patients were absorbed having Langhana and Plavana. In

the study as a whole (30 patients), 9 patients had Asamasthana syanam (30.33%), 5

patients had Urdwa Nireekshanam (16.66%), 4 patients had Diva swapnam (13.33%), 6

patients had Vyayama (20%), 4 patients had Adwaganama (13.33%) 2 patients had yana

(6.66%) No patients were absorbed having Langhana and Plavana.

Showing distributions of patients by Vihara Nidana

4 5

9

4

1

53

1

43 3

6

0 0 00 0 02 2

4

02 2

02468

10


AsamasthanasyanamUrdwaNireekshanamDiva swapnam

Vyayama

Langhana

Phavana

Adwaganama



148

Table No.48 Showing distributions of patients by Manasika Lakshana:

Manasika Group A % Group B % Total %

Chinta 8 53.33% 7 46.66% 15 50%

Shoka 4 26.66% 4 26.66% 8 26.66%

Bhaya 3 20% 4 26.66% 7 23.33%

Among 15 patients in group A, 8 patients had Chinta (53.33%), 4 patients had

Shoka (26.66%), 3 patients had Bhaya (20%), Among 15 patients in group B, 7 patient

had Chinta (46.66%), 4 patients had Shoka (26.66%), 4 patients had Bhaya (26.66%), In

the study as a whole (30 patients), 15 patients had Chinta (50%), 8 patients had Shoka

(26.66%), 7 patients had Bhaya (23.33%),

Showing distributions of patients by Manasika Lakshana

8 7

15

4 4

8

3 4

7

02468

10121416


ChintaShokaBhaya



149

II. DATA RELATED TO THE DISEASE Table No. 49 Distributions of patients by different grades of RUK

RUK Group A % Group B % Total %

Grade 0 0 - - - - -

Grade 1 0 - - - - -

Grade 2 3 20% 4 26.66% 7 23.33%

Grade 3 10 66.66% 9 60% 19 63.33%

Grade 4 2 13.33% 2 13.33% 4 13.33%

Among 15 patients in group A, 3 patients had Grade 2 (20%), 10 patients had

Grade 3 (66.66%), 2 patients had Grade 4 Pain (13.33%), and No patients were having

Ruk in Grade 0 and Grade 1. Among 15 patients in group B, 4 patients had Grade 2

(26.66%), 9 patients had Grade 3 (60%), 2 patients had Grade 4 (13.33%) In the study as

a whole (30 patients), 7 patients had Grade 2 (23.33%), 19 patients had Grade 3

(63.33%), 4 patients had Grade 4 (13.33%), and No patients were having Ruk in Grade 0

and Grade 1.

Distributions of patients by different grades of RUK

0 0 00 0 03 4

710 9

19

2 24

0

5

10

15

20


Grade 0Grade 1Grade 2Grade 3Grade 4



150

Table No. 50 Showing response of patients by different grades of RUK

RUK Group A Group B Total

NR PR MR GR NR PR MR GR NR PR MR GR

Grade 0 - - - - - - - - - - - -

Grade 1 - - - - - - - - - - - -

Grade 2 - 2 1 - - 3 1 - - 5 2 -

Grade 3 - 10 - - 2 5 2 - 2 15 2 -

Grade 4 1 0 1 0 - 2 - - 1 2 1 -

Among 15 patients in group A, 2 patients of Grade 2 had Poor response and 1

patient of Grade 2 had Moderate response. 10 patients of Grade 3 had poor response, 1

patient had no response and 1 patient had Moderate response in Grade 4. In group B 3

patients of Grade 2 were having Poor response and 1 patient had Moderate response. 2

patients had no response while 5 patients are having poor response and 2 patients having

moderate response are seen in Grade 3. 2 patients of Grade 4 are having poor response.



151

Table No.51 Showing distributions of patients by Different grades of Graha

Graha Group A % Group B % Total %

Grade 0 - - - - - -

Grade 1 - - - - - -

Grade 2 4 26.66% 2 13.33% 6 20%

Grade 3 11 73.33% 13 86.66% 24 80%

Grade 4 - - - - - -

Among 15 patients in group A, 4 patients had Grade 2 (26.66%) while 11 patients

had Grade 3 (73.33%), and no patients were observed in Grade 0 ,1 and 4 Among 15

patients in group B, 2 patients had Grade 2 (13.33%), and 13 patients had Grade 3

(86.66%), and No patients were having Graha in Grade 0,1 and 4.

Showing distributions of patients by Different grades of Graha

0 0 00 0 04

26

1113

24

0 0 00

5

10

15

20

25

30


Grade 0Grade 1Grade 2Grade 3Grade 4



152

Table No. 52 Showing response of patients by different grades of Graha Graha Group A Group B Total


Grade 0 - - - - - - - - - - - -

Grade 1 - - - - - - - - - - - -

Grade 2 - 3 1 - - 2 1 - - 5 1 -

Grade 3 - 10 1 - 2 9 2 - 2 19 3 -

Grade 4 - - - - - - - - - - - -


patient of Grade 2 had Moderate response. 10 patients of Grade 3 had poor response, 1

patient of Grade 3 had Moderate response. In group B 2 patients of Grade 2 were having

Poor response and 1 patient had Moderate response. 2 patients of Grade 3 had no

response while 9 patients are having poor response and 2 patients having moderate

response.



153

Table No.53 Showing distributions of patients by different grades of (Passive neck flexion)

Passive neck

flexion


Grade 0 - - - - - -

Grade 1 - - - - - -

Grade 2 10 66.66 % 12 80 % 22 73.33 %

Grade 3 5 33.33 % 3 20 % 8 26.66 %


had Grade 3 (33.33%), and no patients were observed in Grade 0 and 1 Among 15

patients in group B, 12 patients had Grade 2 (80%), and 3 patients had Grade 3 (20%),

and No patients were in Grade 0 and 1.

Showing distributions of patients by different grades of (Passive neck flexion)

0 0 00 0 0

1012

22

53

8

0

5

10

15

20

25


Grade 0Grade 1Grade 2Grade 3



154

Table No. 54 Showing response of patients of patient by different grades of (Passive neck flexion) Passive

neck

flexion



Grade 0 - - - - - - - - - - - -

Grade 1 - - - - - - - - - - - -

Grade 2 - 10 - - 2 8 2 - 2 18 2 -

Grade 3 - 3 2 - - 3 - - - 6 2 -

Among 15 patients in group A, 10 patients of Grade 2 had Poor response. 3

patients of Grade 3 had Poor response and 2 patients had moderate response. In group B

2 patients of Grade 2 were having No response, 8 patients had poor response and 2

patients had Moderate response. 3 patients of Grade 3 had poor response.



155

Table No. 55 Showing distributions of patients by different grades of muscle strength Muscle system Group A % Group B % Total %

Grade 0 - - - - - -

Grade 1 - - - - - -

Grade 2 - - - - - -

Grade 3 - - - - - -

Grade 4 11 73.33% 11 73.33% 22 73.33%

Grade 5 4 26.66% 4 26.66% 8 26.66%


had Grade 5 (26.66%), and no patients were observed in Grade 0,1,2 and 3 Among 15

patients in group B, 11 patients had Grade 4 (73.33%), and 4 patients had Grade 5

(26.66%), and No patients were in Grade 0,1,2 and 3.

Showing distributions of patients by different grades of muscle strength

0 0 00 0 00 0 00 0 0

11 11

22

4 48

0

5

10

15

20

25


Grade 0Grade 1Grade2Grade 3Grade 4Grade 5



156

Table No.56 Showing the over all treatment Response in patient of different grades of Muscle strength in both the treatment Groups (A&B): Muscle

strength



Grade 0 - - - - - - - - - - - -

Grade 1 - - - - - - - - - - - -

Grade 2 - - - - - - - - - - - -

Grade 3 - - - - - - - - - - - -

Grade 4 - 9 2 - - 9 2 - - 18 4 -

Grade 5 - 4 - - 1 2 1 - 1 6 1 -

Among 15 patients in group A, 9 patients of Grade 4 had Poor response, 2

patients of Grade 4 had Moderate response. 4 patients of Grade 5 had Poor response. In

group B 9 patients of Grade 4 were having Poor response, 2 patients of Grade 4 had

Moderate response. 1 patient of Grade 5 had No response, 2 patients had poor response

and 1patient had moderate response.



157

Table No.57 Showing distributions of patients by different grades of Mobility gradings (flexion)

Mobility

gradings

(flexion)


Grade 0 5 33.33% 4 26.66% 9 30%

Grade 1 10 66.66% 11 73.33% 21 70%


had Grade 1 (66.66%). Among 15 patients in group B, 4 patients had Grade 0 (26.66%),

and 11 patients had Grade 1 (73.33%).

Showing distributions of patients by different grades of Mobility gradings (flexion)

5 4

910 11

21

0

5

10

15

20

25


Grade 0Grade 10



158

Table No.58 Showing the over all treatment Response in patient of different grades of Mobility grading (flexion)

Group A Group B Total Mobility

grading

(flexion)


Grade 0 - 4 1 - 1 3 - - 1 7 1 -

Grade 1 - 9 1 - 1 7 3 - 1 16 4 -

Grade 2 - - - - - - - - - - - -


patient of Grade 0 had Moderate response. 9 patients of Grade 1 had Poor response and 1

patient of Grade 1 had moderate response. In group B 1 patient of Grade 0 is having No

response, 3 patients were having Poor response. 1 patients of Grade 1 had No response,

while 7 patients of Grade 1 had Poor response and 3 patients had Moderate response.



159

Table No.59 Showing distributions of patients by different grades of Mobility extension

Extension Group A % Group B % Total %

Grade 0 4 26.66% 4 26.66% 8 26.66%

Grade 1 11 73.33% 11 73.33% 22 73.33%

Grade 2 - - - - - -


had Grade 1 (73.33%). Among 15 patients in group B, 4 patients had Grade 0 (26.66%),

and 11 patients had Grade 1 (73.33%).

Showing distributions of patients by different grades of Mobility extension

4 48

11 11

22

0 0 00

5

10

15

20

25


Grade 0Grade 1Grade 2



160

Table No.60 Showing the over all Response in patient of different grades of Extension

Group A Group B Total Extension NR PR MR GR NR PR MR GR NR PR MR GR

Grade 0 - 3 1 - 1 3 - - 1 6 1 - Grade 1 - 10 1 - 1 7 3 - 1 17 4 - Grade 2 - - - - - - - - - - - -


patient of Grade 0 had Moderate response. 10 patients of Grade 1 had Poor response and

1 patient of Grade 1 had moderate response. In group B 1 patient of Grade 0 is having No

response, 3 patients were having Poor response. 1 patients of Grade 1 had No response,

while 7 patients of Grade 1 had Poor response and 3 patients had Moderate response.

Table No.61 Showing distributions of patients by different grades of Lateral flexion

Lateral flexion


Grade 0 5 33.33% 3 20 8 26.66% Grade 1 10 66.66% 12 80 22 73.33% Grade 2 - - - - - -


had Grade 1 (66.66%). Among 15 patients in group B, 3 patients had Grade 0 (20 %), and

12 patients had Grade 1 (80 %).

Showing distributions of patients by different grades of Lateral flexion

5 3810 12

22

0 0 005

10152025





161

Table No.62 Showing the over all Response in patient of different grades of Lateral flexion

Group A Group B Total Lateral flexion NR PR MR GR NR PR MR GR NR PR MR GR Grade 0 - 3 2 - 2 1 1 - 2 4 3 - Grade 1 - 10 - - - 8 3 - - 18 3 - Grade 2 - - - - - - - - - - - -


patients of Grade 0 had Moderate response. 10 patients of Grade 1 had Poor response. In

group B 2 patients of Grade 0 is having No response, 1 patient is having Poor response, 1

patient of Grade 0 had Moderate response. 8 patients of Grade 1 had Poor response and 3

patients had Moderate response.

Table No.63 Showing distributions of patients by different grades of Rotation in both the treatment Groups (A&B):

Rotation Group A % Group B % Total % Grade 0 1 6.66% 1 6.66% 2 6.66% Grade 1 14 93.33% 14 93.33% 28 93.33% Grade 2 - - - - - -

Among 15 patients in group A, 1 patient had Grade 0 (6.66%) while 14 patients

had Grade 1 (93.33%). Among 15 patients in group B, 1 patient had Grade 0 (6.66 %),

and 14 patients had Grade 1 (93.33 %).

Showing distributions of patients by different grades of Rotation in both the treatment Groups

(A&B):

1 1 2

14 14

28

0 0 00

10

20

30

Group A Group Total




162

Table No.64 Showing the over all Response in patient of different grades of Rotation

Group A Group B Total Rotation NR PR MR GR NR PR MR GR NR PR MR GR

Grade 0 - 1 - - 1 - - - 2 - - - Grade 1 - 12 2 - - 12 2 - - 24 4 - Grade 2 - - - - - - - - - - - - Among 15 patients in group A, 1 patient of Grade 0 had Poor response. 12 patients of

Grade 1 had Poor response. 2 patients of Grade 1 had moderate response. In group B 1

patient of Grade 0 is having No response, 12 patient is having Poor response, 2 patient of

Grade 1 had Moderate response.

III. Data Related to Overall Responses to the Treatment Table No.65 Showing distributions of patients by different grades to Over all Response

Response Group A % Group B % Total % Good - - - - - - Moderate 2 13.33% 3 20% 5 16.66% Poor 13 86.66% 10 66.66% 23 76.66% No response - - 2 13.33% 2 6.66%

Among 15 patients in group A, 2 patients had Moderate response (13.33%) while 13

patients had Poor response (86.66%). Among 15 patients in group B, 3 patients had

Moderate response (20 %), and 10 patients had Poor response (66.66 %) and 2 patients

had no response (13.33 %) No patient is having good response in both the Groups.

Showing distributions of patients by different grades to Over all Response

0 0 02 3 5

1310

23

0 2 205

10152025

Group A Group B TOTAL

GoodModeratePoorNo response



163

Table No. 66 Showing Overall response of each parameter

Parameter Group % Remarks A Ruk B

53.88 Moderate Response

A Graha B 53.325 Moderate Response

A Passive neck flexion

B 52.22 Moderate Response

A Muscle strength B 3.33 Poor Response

A F B 23.33 Poor Response

A E B 14.995 Poor Response

A Lf B 14.995 Poor Response

A

Mobility grading

R B

13.33 Poor Response

The parameters Ruk, Graha and passive neck flexion showed moderate response in

overall assessment, while Mobility and Muscle strength showed poor response in overall

assessment.



164

Table No. 67 Master Chart of Subjective and Objective Parameters. Opp

Num

RUK Graha Passive

neck

flexion

Mobility Muscle

strength

Remarks

Flexion Extension L.F R

B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T

2610 3 1 3 2 2 1 0 1 1 1 1 1 1 1 4 4 PR

2310 3 2 2 1 2 1 1 1 1 1 1 1 1 1 4 4 PR

2267 3 1 3 2 2 1 0 1 1 1 1 1 1 1 5 5 PR

2214 3 2 3 1 2 1 1 1 0 1 0 1 1 1 4 3 PR

2482 2 0 2 1 2 1 1 1 0 1 1 2 1 1 4 4 PR

3399 3 1 3 2 2 1 1 2 1 1 1 1 1 1 4 4 PR

3704 4 3 3 2 3 2 1 1 0 1 0 1 0 1 5 5 PR

3701 3 2 2 1 3 2 0 1 1 1 1 1 1 1 5 5 PR

3635 3 1 3 2 2 1 1 1 1 2 1 1 1 1 4 4 PR

4238 3 2 3 1 2 1 0 1 1 1 1 1 1 1 4 4 PR

4277 3 1 3 2 3 2 1 1 1 1 1 1 1 1 4 4 PR

4735 2 1 3 0 3 2 1 1 1 1 0 1 1 1 5 5 MR

4721 3 2 3 1 2 1 1 1 1 1 1 1 1 2 4 4 PR

925 2 1 3 2 2 1 1 1 1 1 0 1 1 1 4 3 PR

4144 4 3 2 1 3 2 0 0 0 1 0 0 1 1 4 4 MR

1195 2 1 3 1 2 1 1 1 1 1 1 1 1 1 4 4 PR

2382 2 0 3 1 2 1 1 1 1 1 1 1 1 1 4 3 MR

1644 3 2 3 1 2 0 1 1 1 1 1 1 1 2 4 4 PR

2305 3 1 3 0 2 1 1 2 1 2 1 0 1 0 5 5 MR

1443 3 1 3 1 2 1 1 1 1 1 0 0 1 0 4 5 MR

1035 3 1 3 2 2 1 1 1 1 1 1 1 1 2 5 5 PR

2638 2 1 3 2 2 1 0 1 0 1 1 1 1 1 5 5 PR

4729 3 1 2 1 3 2 1 2 1 2 1 1 1 1 4 4 PR

2539 4 2 3 1 3 1 0 1 0 1 1 1 1 2 5 5 PR

3916 3 2 3 1 2 1 0 1 0 1 0 1 1 2 5 5 NR

3779 4 2 3 1 3 1 0 1 0 1 1 2 1 1 4 5 PR

3807 3 1 3 1 2 1 1 2 1 2 1 2 1 2 4 4 PR

4271 3 2 3 2 2 1 1 2 1 2 0 1 0 1 4 4 NR

4730 2 0 3 2 2 1 1 1 1 1 1 1 1 1 4 4 PR

278 3 2 2 1 2 1 1 2 1 2 1 1 1 2 4 3 PR



165

IV. Statistical analysis of the clinical and functional parameters and intergroup comparison.

Table No.68 Showing Statatical analysis of Group A

Parameter Mean S.D S.E t-Value P -Value Remarks

Ruk 1.4 0.507 0.130 10.76 < 0.001 H.S

Graha 1.333 0.617 0.159 8.38 <0.001 H.S

Passive neck

flexion

1.00 0.00 - - - -

Muscle

strength

0.133 0.351 0.09 1.48 >0.05 N.S

F 0.266 6.457 0.118 2.25 <0.05 H.S

E 0.333 0.487 0.125 2.664 <0.02 H.S

Lf 0.266 0.457 0.118 2.254 <0.05 H.S

Mobility

Grading

R 0.133 0.351 0.09 1.477 >0.05 N.S

Table No. 69 Showing Statatical analysis of Group B Parameter Mean S.D S.E t-Value p-Value Remarks

Ruk 1.6 0.507 0.131 12.21 <0.001 H.S

Graha 1.666 0.617 0.159 10.477 <0.001 H.S

Passive neck

flexion

1.266 0.457 0.118 10.728 <0.001 H.S

Muscle

strength

0.2 0.414 0.106 1.886 >0.05 N.S

F 0.6 0.507 0.130 4.615 <0.001 H.S

E 0.333 0.487 0.125 2.664 <0.002 H.S

Lf 0.266 0.457 0.118 2.254 <0.05 H.S

Mobility

Grading

R 0.6 0.507 0.131 4.58 <0.001 H.S



166

Table No.70 Showing Comparative statistical analysis of both Groups (A & B).

Sl.No Parameters Group Mean S.D S.E P.S.E t- value

P - value

Remarks

A 1.533 0.833 0.215 1 Ruk

B 1.266 0.703 0.181

0.281 0.95 >0.05 N.S

A 1.4 0.632 0.163 2 Graha

B 1.2 0.560 0.144

0.217 0.921 >0.05 N.S

A 1.333 0.487 0.125 3 Passive neck flexion B 1.00 0.377 0.097

0.158 2.107 <0.05 H.S

A 4.4 0.507 0.131 4 Muscle strength

B 4.533 0.516 0.133

0.186 0.715 >0.05 N.S

A 1.00 0.377 0.097 F B 1.333 0.487 0.125

0.159 2.094 <0.05 H.S

A 1.066 0.258 0.066 E B 1.00 0.53 0.138

0.152 0.434 >0.05 N.S

A 0.933 0.457 0.118 Lf

B 1.2 0.414 0.106

0.159 1.679 >0.05 N.S

A 1.066 0.258 0.066 0.1933 1.034 >0.05 N.S

5 Mobility grading

R B 1.266 0.703 0.181

Conclusion

To compare the mean effect of two groups the statatical analysis is done by using

unpaired ‘t’ test. Assuming that the mean effect in the two groups in all the parameters is

same after the treatment.

From the analysis the parameter mobility grading flexion and passive neck flexion

shows highly significance ( as ‘P’ is less than 0.05). The parameter passive neck flexion

is most significient than other parameters (By comparing ‘t’ values).

The parameter muscle strength, the mean effect is more and the passive neck

flexion is less in a Group B after the treatment and there is a much variation in the



167

parameter of ‘Ruk’ of Group A after the treatment (By comparing mean and standard

deviation)

To compare effect of drug within the Group this statatical analysis is using by

paired ‘t’ test by assuming that the drug is not responsible for the changes in the

observation before and after the treatment. From the analagesic, in Group B the

parameters Ruk, Graha, and passive neck flexion shows more highly significance than the

Group A (By comparing ‘t’ values).

The parameter muscle strength shows not significant both the Groups (A& B).

The mobility grading in Group B of parameter flexion, Rotation, shows more

highly significant. The parameter extention and lateral flexion shows equal highly

significant in both the Groups. But the Rotation in Group A shows not significant. (By

comparing ‘P’ Value and ‘t’ Value)

V. Statistical analysis of Nasyakarmukata Table No.71 Showing the response of Nasyakarmukata in Group A.

Opp Num

Sukauchvasam Sukhaswapnam Sukha Bodha

Aksha padavam

B.T A.T B.T B.T A.T A.T B.T A.T 2610 0 2 0 2 0 2 1 2 2310 0 1 0 2 0 2 0 2 2267 0 2 1 2 0 1 1 2 2214 0 1 1 1 1 2 1 2 2482 0 2 1 2 1 2 0 2 3399 0 1 0 2 1 1 1 2 3704 0 2 0 1 0 2 0 2 3701 0 1 1 2 0 2 1 2 3635 0 2 1 2 0 2 1 2 4238 0 1 1 2 0 2 1 1 4277 0 2 1 1 0 2 0 1 4735 0 1 1 1 1 1 1 1 4721 0 2 0 2 1 0 0 2 925 0 2 0 2 1 0 1 2 4144 0 1 0 2 0 2 1 2



168

Table No.72 Showing the response of Nasyakarmukata in Group B.

Opp Num

Sukauchvasam Sukhaswapnam Sukha Bodha

Aksha padavam

B.T A.T B.T B.T A.T A.T B.T A.T 1195 0 2 0 1 0 2 1 2 2382 0 2 0 2 1 2 0 2 1644 1 1 1 2 1 1 1 2 2305 1 1 1 1 1 1 1 2 1443 1 1 1 2 0 1 0 2 1035 0 1 0 2 0 2 1 2 2638 0 1 1 2 1 2 0 1 4729 0 1 1 2 0 2 1 2 2539 0 1 1 2 0 2 0 1 3916 0 1 0 2 0 2 1 2 3779 0 1 1 2 0 2 0 2 3807 0 1 0 2 1 2 1 1 4271 0 2 0 2 1 2 1 1 4730 0 1 0 1 1 1 1 1 278 0 2 1 2 1 2 1 2

Table No. 73 Showing Statatical analysis of Nasyakarmukata in Group A

Parameter Mean S.D S.E t-Value P -

Value

Remarks

Sukhauchvasam 1.066 0.703 0.181 5.889 <0.001 H.S

Sukha

swapanam

1.333 0.617 0.159 8.383 <0.001 H.S

Sukha Bodha 1.2 0.774 0.2 6.00 <0.001 H.S

Akshipadavam 1.00 0.654 0.169 5.917 <0.001 H.S

Table No.74 Showing Statatical analysis of Nasyakarmukata in Group B

Parameter Mean S.D S.E t-Value P -Value

Remarks

Sukhauchvasam 1.533 0.516 0.133 11.526 <0.001 H.S Sukha swapanam

1.733 0.457 0.118 14.686 <0.001 H.S

Sukha Bodha 1.133 0.743 0.191 5.93 <0.001 H.S Akshipadavam 1.133 0.639 0.165 6.866 <0.001 H.S



169

VI. Statistical analysis of Swedakarmukata

Table No.75 Showing the response of Swedakarmukata in Group-A.

Agnideepti Bhakta shraddha

Tandra hani

Sandhi cheshta

Sroto nirmalatwa

Mardava Twak prasada

Sl. No.

B A B A B A B A B A B A B A 01. 0 2 0 1 0 1 1 3 3 1 0 1 0 2 02. 0 2 0 1 0 1 1 3 3 1 0 2 0 2 03. 0 2 1 1 0 1 1 2 3 2 1 2 1 2 04. 1 2 1 1 0 1 1 2 4 3 0 2 0 2 05. 1 2 1 1 0 1 1 2 4 2 1 2 1 2 06. 1 2 1 1 0 1 1 2 3 2 1 2 0 1 07. 0 2 0 1 1 1 2 3 4 2 1 2 1 2 08. 1 2 1 1 0 1 2 2 4 2 0 1 0 1 09. 0 1 0 1 0 1 2 3 3 2 0 1 0 1 10. 1 2 0 1 0 1 1 2 3 1 0 1 0 1 11. 0 2 0 1 0 1 1 2 3 2 0 1 0 0 12. 1 2 1 1 0 1 1 3 3 2 0 1 0 1 13. 0 1 0 1 0 1 2 3 3 2 0 1 0 1 14. 1 2 1 1 0 1 1 3 4 2 1 2 1 1 15. 0 2 0 1 0 1 1 2 3 2 0 1 0 1 Table No.76 Showing the response of Swedakarmukata in Group-B.

Agnideepti Bhakta shraddha

Tandra hani

Sandhi cheshta

Sroto nirmalatwa

Mardava Twak prasada

Sl. No.

B A B A B A B A B A B A B A 16. 0 1 0 1 0 1 2 3 3 3 0 0 0 0 17. 0 1 0 1 0 1 1 2 4 2 1 1 1 2 18. 0 1 0 1 0 1 1 3 4 2 1 1 1 2 19. 0 1 0 1 0 1 1 3 3 2 0 1 0 2 20. 1 1 1 1 0 1 1 2 3 2 0 1 0 0 21. 0 1 0 1 0 1 1 2 3 2 1 1 1 2 22. 0 1 0 1 0 1 1 2 3 3 0 1 0 1 23. 0 1 0 1 0 1 1 2 3 2 0 1 0 1 24. 0 1 0 1 0 1 2 3 3 3 0 0 0 1 25. 0 2 0 1 0 1 2 3 3 2 0 1 0 1 26. 0 1 0 1 0 0 2 3 3 3 0 0 0 1 27. 0 1 0 1 0 1 2 3 4 3 0 1 0 1 28. 0 1 0 1 0 1 2 3 3 3 0 1 0 1 29. 0 1 0 1 0 1 2 3 3 3 0 0 0 1 30. 0 1 1 1 0 1 2 3 3 2 0 1 0 0



170

Table No.77 Showing the study of Sweda kaarmukata parameters of Group-A. Parameters Mean S.D S.E t-value p-value Remarks Agnideepti 1.866 0.351 0.0908 10.664 <0.001 H.S. Bhakta shraddha 0.533 0.516 0.133 4.00 <0.01 H.S. Tandrahani 0.933 0.258 0.066 14.13 <0.001 H.S. Sandhi cheshta 1.133 0.1516 0.133 8.518 <0.001 H.S. Srotonirmalatva 1.866 0.516 0.133 14.03 <0.001 H.S. Mardava 1.466 0.516 0.133 11.02 <0.001 H.S. Twak prasada 1.33 0.617 0.159 8.383 <0.001 H.S. Table No.78 Showing the study of Sweda kaarmukata parameters of Group-B. Parameters Mean S.D S.E t-

value p-value

Remarks

Agnideepti 1.066 0.256 0.066 16.00 <0.001 H.S. Bhakta shraddha

0.866 0.351 0.0903 9.537 <0.001 H.S.

Tandrahani 0.866 0.351 0.0908 9.537 <0.001 H.S. Sandhi cheshta 2.26 0.351 0.0908 12.47 <0.001 H.S. Srotonirmalatva 2.466 0.516 0.133 18.54 <0.001 H.S. Mardava 0.733 0.457 0.118 6.211 <0.001 H.S. Twak prasada 1.066 0.153 0.153 6.967 <0.001 H.S. To know the Swedakaarmukata in both the groups the parameters were analyzed.

In group-A the parameter Agni deepti showed more significance than the other

parameters and also it differs from the group-B, by comparing the t-values. The

parameter Agni deepti had uniform effect in group-A but in group-B the parameter

Srotonirmamatva had uniform effect. The mean effect of the parameter Sandhi cheshta in

group-A and the parameter Tandra haani was more and same in both the groups. The

variation in Sandhi chesta in group-A was more whereas the parameters Srotonirmalatva

and Mardava had the same mean effect. The parameter Twak prasada in group-B had

more variation whereas the parameters Tandra haani and Mardava had the same

variations.


Discussion

171

Any hypothesis or principle, if to be proved must be discussed thoroughly from

all angles, which has been clearly stated by Charaka long back. After the formation of a

hypothesis, it has to be tested and observed by various methods and eventually the results

are obtained. All these should be well supported by proper reasoning or logic and finally

concluded. A hypothesis gets established as a principle if the reasoning given is

satisfactory, otherwise it remains as it is. Charka has very precisely said that, even the

truth may not be accepted, as it is without the logical interpretation.

Discussion improves the knowledge and discussion with science becomes base

establishment of the concept. Thus discussion is the most essential phase of any research

work. Keeping this in view, the facts which have emerged from the study can be studied

in 4 main headings.

1) Discussion on Manyasthambha

2) Discussion on Karmas.

3) Discussion on clinical study.

Discussion on demographic data.

Discussion on disease data.

4) Discussion on results.

1. Discussion on Manyasthambha

These are osteo-arthritis of spinal joints of cervical and lumbar regions. Here the

straightening of the two curved regions of spine causes entrapment of the nerve roots

emerging out of spinal canal. This gives neurological symptoms depending on the type of

nerve.


Discussion

172

Cervical spondylitis causes sensory / motor symptoms of posterior head and neck,

shoulders, upper limb regions as pain, numbness, burning, weakness etc. Giddiness on

neck movements and inter vertebral prolapse are later complications.




extremity the brachial plexus is affected. The trapezius area becomes tender and painful.

A nodule can form in the muscle due to chronic pressure. The symptoms of cervical cord

compression can sometimes be severe. The pain radiates down the right or left arm to the

fingers, to the chest and shoulder blades depending on which side the nerve root is

involved. It can become continuous, making movements painful and limited. If the

cervical vertebrae become unstable, the danger of cord compression is imminent and, in

some cases, fusion of the bones may be warranted. But this is rare.

Causes of Manyasthambha

Considering the reference of Manyasthambha to cervical Spondylitis the better

comparison can be made from the Nidana. The main Nidana can be considered fewer

than 4 headings.

1. Swaprakopa Nidana – including Ahara Nidana

2. Margavarodhaka Nidana – causing obstruction to Vata

3. Marmaghata kara Nidana – injury/trauma

4. Dhatukshayaka Nidana – depletion of Dhatu

Though these are considered different Nidana bhavas ultimately they are inter

related. But to know the exact cause for the onset of disease such a classification has been


Discussion

173

made. The swaprakopa nidanas, marmabigata and margavarodhaka nidanas eventually

leads to Dhatukshaya and there by provoke the vata. Spondylotic changes often are

observed in the ageing population. However, only a small percentage of patients with

radiographic evidence of cervical Spondylitis are observed.

Stress and long working hours in front of computers can lead to cervical pain as

well as pathological abnormalities. The commonest cause for cervical Spondylitis or such

type of diseases is the Inflammatory and degenerative changes effected in the cervical

region. Anti inflammatory, analgesic and disease modifying anti rheumatic drugs are the

drugs of choice in contemporary system of medicine.

In take of excessive and heavy fatty meals were observed to lead to accelerated

Inflammatory and degenerative process and can be considered as Kapha provocative diet.

The posture of work i.e., looking upward direction lying on irregular surface etc. are

considered as the cause for cervical Spondylitis. The psychological factors Shoka, Bhaya,

chinta etc. lead to provocation of vata and intern leads to degenerative diseases. So all

these factors can be considered as the swaprokopa Nidana factors in Ayurveda.

Trauma is observed to be the next causative factor for the disc prolapse. Trauma

or abigatha to the marmas are considered here. Almost all the patients of cervical

Spondylitis have a history of trauma or bad postures which in turn leads to improper

positioning of cervical vertebrae, this puts uneven pressure over the spinal nerve roots

producing different signs and symptoms.

It is observed that when a person sleeps with improper head position, especially in

middle aged or old aged, develop Inflammatory and degenerative processes in the

cervical vertebrae, and may lead to Manyasthambha. Spondylitis is due to ageing process


Discussion

174

or with wrong postures causing minor trauma, which can accelerate the pathology of

Manyasthambha and further degeneration leading to set a clinical features.

The Ahara and vidhara as elucidated in the Nidana induces reduction of sneha

bhavas and simultaneously Vata prakopa i.e., Vyanavata that normally controls all the

movements of the body due to Dhatu kshaya. Reduction of sleshmaka Kapha, which

normally align the joints, causes the vitiated Vata to settle in the joints.

2) Discussion on Karmas.

Manyastambha is a vatavyadhi by its nature. The condition manyastamba is

affecting the neck region with the symptoms such as pain and stiffness. Vata is vitiated

either because of Avarana or Dhathukshya when vata covered by kapha or Dosha

accumilation makes Manyastambha. In initial stage of the disease the kapha anubandam

is acknowledge. Ayurveda advocates a reliable management of this condition through

highly efficiencies and easily available drugs based on doshic theory. Ayurvedic

approach to the disease management of Manyastambha is to retard the inflammation and

degeneration and to strengthen the dhathus and passifing the vata dosha which has a

special importance in the management.

In the classic, the treatment is told as Rooksha sweda and Nasya where we

consider manyastambha in the doshic level as vata and kapha are the two main factors

involved in the pathogenesis of Manyasthambha. Here the pain and stiffness are two

symptoms present in the disease which can be attributed the vata and kapha dosha

lakshna Rooksha sweda is told for srotoshodhana there by subside the vitiated kapha

which is in the Manyapredesha and for this purpose, Kolakulathadi choorna is used

which relieves the pain and stambatwa. By swedana we can get the effects like twak


Discussion

175

mruduta, twakprasada, srotoshodhana, stabdhatwa in the sandhis are relieved and

becomes easy for chesta.

Charaka while explaining the effects of swedana he says it is best in sankocha,

ayama, shoola, sthambha etc. all the vikaras of sarvanga and ekanga.

Kolakulathadi Choorna

Most of the ingredients of kola kulatthadi churna are having Laghu ushna snigdha

gunas and kapha vata hara properties. Manyasthambha being a vataja vyadhi with kapha

avarana gets regressed by the usage of this choorna as Rooksha sweda.

Nasya karma is the first line of management explained in the classic for

urdwajatru gata vatavyadhi, Manyasthambha being one of the urdwajatru gatha vikara

and especially dhatu kshayajanya vata roga hence Brahmana type of nasyakarma is more

beneficial. Brahmana nasya karma has been selected for the study because the disease

Manyasthambha is degenerative in orgin and Urdwajatagata vata vyadhi. Hence

nasyakarma with Mahamasha thaila is best advisible to palliate the disease which helps to

set right the disease as it being santarpana type of chikitsa which prepared with vatahara

drugs. As per the Bruhmana Nasya karma mechanism is concerned it could be

hypothesized that it acts on local as well as systemic levels by the direct contact with the

nerve terminals and also uptake of the drugs by nasal mucosa. Hence Nasyakarma not

only acts as curative but also acts on prevantive measure.

Nasya dravya reaches the shringataka marma of head (sheera) which is a sira

marma and formed by the siras of nose, eyes, kanta, and shrotra. The drugs spreads by the

same route and scratches the morbid doshas of urdhajatru and excreate them from the

uttamaga.


Discussion

176

Indu, commentator of Asthanga sangraha, opined that shringataka is the inner side

of middle part of head “shiraso antar madhyam.”

In this contex susruta, clarified the shringataka marma is a siramarma forced by

the union of sira (blood vessels) supplying to nose, ear, eye and tongue thus we can enter

the above sira and purities them.

Mahamasha Thaila

By virtue of its qualities like guru, snigdha teekshna, madhurvipaka, ushna veerya

is vata shamaka property, vedana sthapaka, shoola hara, nadidourbalyahara, balyam

Bruhmana, shodhaharam, anulomana rasayanam acts on dathukshaya most of the

ingredients are antagonistic to nadi dourbalyam and reinstaling it to normalcy.

Mode of action of Nasya

The absorption of the drugs is carried out in three media they are by general blood

circulation, after absorption through mucous membrane. The direct pooling into Venus

sinus of brain via inferior ophthalmic veins and next one absorption directly in to the

cerebra spinal fluid. Apart from the small emissary veins entering cavernous sinuses of

the brain, a pair of venous branch emerging from alliance will drain into facial vein. Just

almost in the opposite direction inferior ophthalmic in other hand also drain into

cavernous sinus of the menages. And in addition neither the facial vein nor the

ophthalmic veins have any venial values so there are more chances of blood draining

from facial vein into the cavernous sinus in the lowered head position.

The nasal cavity directly opens with the frontal maxillary and sphenoidal air sinus

epithelial layer is also continuous through out then the momentary retention of drug in

naso pharynx. Medicine causes oozing as drug material enters into air sinus, which are


Discussion

177

rich with blood vessels entering the brain and remaining through the existing foramens in

the bones there are better chances of drug transportation in this path. Recent authors as

middle cephalic fosse of the skull consisting para-nasal sinus and meningial vessels and

nerves one can see in to the truth of narration made have explained the shringataka

marma by Vagbhata here. The drug administered enters the para nasal sinus especially

frontal and sphenoid sinus i.e., shringataka where the ophthalmic veins and the other

veins spread the sphenoid sinus are in close relation with intra-cranial structures. Thus

there may be a so far undetected route between air sinuses and cavernous sinuses

enabling the transudation of fluids. As a whole, the mentioning of the shringataka in this

context seems to be more reasonable.

3) Discussion on Clinical study

Discussion on Demographic data:

All the cases were reported to D.G.M Ayurvedic medical college hospital, post

graduation department. Special medical camps were also conducted in the college

for selecting the patient. 33 cases were registered and from that 30 cases were

selected for the study. Observed features in the patients during the study were

recorded in the case sheets and these observations were analyzed and tabulated

after completion of clinical study. These observations findings are discussed

below.

♦ Age

Risk of cervical spondylitis as age advances because of increase in the

inflammatory and degenerative conditions in the cervical spin and its

surroundings structure, especially after 35 years of age. It is also recorded fact


Discussion

178

that cervical spondylitis occurs frequently in 35-40 years of age. In this study

above factors where proved as the maximum number of patients between 30-40

years of age (33.33%)

♦ Sex

It is said that males are more affected in comparison to females in

Manifestation of cervical spondylities and ratio is given as 3:1 for male to female

ratio. In this study the above said statement is having a significance as number of

male patients are more that is 19 patients (63.33%) out of 30 females being only

11 (36.66%).

♦ Food habits

In the manifestation of vata vyadhi food habits place a pivotal role. If we

check the nidana aspects we can see the importance of food habits in the present

study. Only 8 patients were registered as vegetarians and remaining 22 patients

were seen as mixed diet consumer. This condradictory observations may be due to

the small sample size and study limited to a particular area.

♦ Religion

In the present study majority of the patients where Hindus i.e. 22 patients

(80%). But does not mean that Hindus are more prone to the disease. This may be

due to the area involved as majority of population are hindus.

♦ Occupation

Maximum number of patients are with active life style 13 (43.33%) and

labours are registered only 8 in number (26.66%) it is said that cervical

spondylitis frequently occurs in the patients who are weight lifters doing heavy


Discussion

179

exercises etc. The low incidence of labourers in comparision to active and

sedentary people may be due to the small sample size and random selection of

patients.

♦ Social economical status

In the present study the maximum number of patients were found in

middle class that is 26 patients this may be due to the small sample size and

randomly selection of patients.

Discussion on disease data

• Deha prakruthi

In the present study the majority of the patients were of vata pitta

prakruthi 15 patients (50%) and next dominent prakruthi is vata kapha which are

9 in number least are pitta kapha patients with 6 in numbers (20%) the

significance of increased number of vata pitta prakruthi is may be due to the

geographical area were the study is conducted.

• Agni

In the present study the majority of the patients were of mandagni 15

patients (50%) and next dominent Vishama which are 8 (26.66%) in numbers

least are Samaagni patients with 7 in numbers (23.33%) the significance of

increased number of Mandagni is may be due to the geographical area were the

study is conducted.

It is explained that Ama which may characterstic feature due to mandagni

acts as a strong nidana for manifectation of vata vyadhi and Manyasthambha in

particular because in the initial stages of Manyasthambha there will be vata


Discussion

180

avarana by kapha which can be assumed as a resultant of increased amathva in the

body.

• Koshta

In the present study the majority of the patients were of madyama 19

patients (63.33%) and next dominent Koshta is Krura which are 8 in numbers

least are Mrudu koshta patients with 2 in numbers (6.66%) the significance of

increased number of madyama koshta is may be due to the geographical area were

the study is conducted.

• Nidra

In the present study the maximum patients were having Alpa nidra that is

13 in number (43.33) and the next dominent type of Nidra is Vishama nidra were

9 patients are seen. High incidence of Alpa and vishama Nidra is may be due to

the increased pain and inturn disturbing the sleep.

• Nidanam

Most of the Nidanas mentioned in the classics were elicited in the study,

among the ahara nidana all the patients where in the habit of taking vata

vriddhikara ahara. In the vihara group the prominent nidanas were found as urdwa

nireekshanam, Asamastana sayanam, Vyayamam from these we can say that this

Nidanas had key role in the pathogenesis of Manyasthambha.

• Chronicity

Here in this study, the maximum number of patients were having

chronicity ranging from 6 months to 1 year 14 Next highest number of patients


Discussion

181

were found having the chronicity of 1 year to 1½ year 11 patients. This

observation is due to the radomised clinical study.

4) Discussion on Results

All the cases were reported to D.G.M Ayurvedic medical college hospital,

post graduation department. Special medical camps were also conducted in the

college for selecting the patient. 33 cases were registered and from that 30 cases

were selected for the study. Observed features in the patients during the study

were recorded in the case sheets and these observations were analyzed and

tabulated after completion of clinical study. These observations findings are

discussed below.

The result of the study confirmed that Rookshasweda has highly

significant in Ruk Graha extension and lateral flexion of neck in group A.In group

A muscle strength and Rotation did not showed no significant result.

In group B muscle strength showed no significant result, and rest of

parameters showed highly significant results. This increased significance of the

parameters is may be due to the additive effect of Nasya along with sweda.

The muscle strength is having no significance and it is due to the very

small study duration of 14 days. So we cannot expect any significant result by

Nasya and swedana. More patients are not having any change in the muscle

strength because majority of the patients having normal muscle strength. Very

few patients shown the muscle weakness during the study it was unchanged.


Discussion

182

To compare the mean effect of two groups the statatical analysis is done

by using unpaired ‘t’ test. Assuming that the mean effect in the two groups in all

the parameters is same after the treatment.

From the analysis the parameter mobility grading flexion and passive neck

flexion shows high significance ( as ‘P’ is less than 0.05). The parameter passive

neck flexion is most significient than other parameters (By comparing ‘t’ values).

The parameter muscle strength, mean effect is more and the passive neck

flexion is less in Group B after the treatment and there is a much variation in the

parameter of ‘Ruk’ of Group A after the treatment (By comparing mean and

standard deviation)

To compare effect of drug within the Group this statatical analysis is using

by paired ‘t’ test by assuming that the drug is not responsible for the changes in

the observation before and after the treatment. From the analagesic, in Group B

the parameters Ruk, Graha, and passive neck flexion shows more highly

significance than the Group A (By comparing ‘t’ values). The parameter muscle

strength shows not significant both the Groups (A& B). The mobility grading in

Group B of parameter flexion, Rotation, shows more highly significant. The

parameter extention and lateral flexion shows equal highly significant in both the

Groups. But the Rotation in Group A shows not significant. (By comparing ‘P’

Value and ‘t’ Value)


Conclusion

183

The following conclusions are drawn on the basis of the research undertaken with

the Rookshaswedasthada Nasyam at D.G.M. Ayurvedic medical college and Hospital,

Gadag.

• The disease Manyasthambha and cervical Spondylitis are similar in their etiology,

sign and symptoms.

• The Dosha entities included in this disease are Vyanavata and Sleshmaka Kapha.

• Manyasthambha is one of the Vataja Nanatmaja vyadhis.

• The initial stages the vata avarana by kapha is seen leading to Stambatwa, Gaurava,

and Ruk.

• Males and aged people are more affected than females.

• Inflammatory and degenerative joint changes being progressive and irreversible

treatment is aimed at the relief of the symptoms and to check the disease process, to

induce regeneration if possible.

• Rooksha sweda karma is a modification of the sankara sweda (or sagni upanaha)

that comes under ushma type of swedana.

• No complications of sweda (atiyoga, ayoga and mitya yoga) were absorbed in this

study.

• No complications of Nasya (atiyoga, ayoga and mitya yoga) were absorbed in this

study.

• During the follow up period (after the 28th day) the results attained seemed to wear

out in the Rooksha sweda group, but results lasted throughout the follow up period

in the Rooksha sweda along with Nasya group.


Conclusion

184

• In group B, the parameters (Ruk) Graha and passive neck flexion shares more

highly significant then the group A (By comparing t valuves) the parameter muscle

strength shows not significant in both the groups.

• In group B values shows more highly significant when compare to group A, and

this may be due to the addictive effect of Nasya karma.

Suggestions for the future study

1) Study on large sample.

2) Studying on repeated application of these treatment procedure may be conducted

and progress studied.


Summary

185

The dissertation work entitled “The clinical study on Rooksha swedasthada

Nasyam in the management of Manyastambha (Cervical spondylitis)” consists of

seven parts. They are

• Introduction

• Objectives

• Review of Literature

• Methodology

• Results

• Discussion

• Conclusion

The Introduction highlights on Rooksha sweda, Nasya and Manyasthamba. The

objectives part describes the need for the study, previous studies on Manyasthambha, title

of the present study and the objectives of the present study Review of literature part

covers the historical view on Nasya, sweda an Manyasthambha, Nirukthi and paribhasa

of Rookshasweda, Nasya and Manyasthambha shareera of Twak description of

swedakarma and Rooksha sweda in particular and description of Manyasthambha.

Methodology part contains review of properties and chemical composition of the drugs

used, Methodology of the clinical study, procedures of Rooksha sweda and Nasya and the

parameters for clinical and functional assessment and the Nasya Karmukatha and

swedakarmukatha parameter. Discussion part consists of the headings, Discussion on

Manyasthambha, Discussion on Karma, Discussion on clinical study, Discussion on

results. Conclusion part contains the conclusions of the present study and suggestion for

the future study.


References 1. P.S. Varier, Chikitsa samgraham. Calicut : Aryavaidya sala: 1991 P.No. 155. 2. Vagbhata, Astanga Hrudayam sustrastana chapter 14 sloka 5, Varanasi:

Chaukhamba Orientalia: 1982 P. 233 (Krishnandas academic series Vol. 4)

3. Vagbhata, Astanga Hrudayam sustrastana chapter 20 sloka 1, Varanasi: Chaukhamba Orientalia series: 1982 P. 233 (Krishnandas academic series Vol. 4)

4. Vagbhata, Astanga Samgraham sustrastana chapter 20 sloka 2, Thrissur:

manglodayam press: 1914.P. 224.

5. Vagbhata, Astanga Samgraham sustrastana chapter 20 sloka 9, Thrissur: manglodayam press: 1914.P. 224.

6. Cervical spondylitis and ankolysing spondyloarthropathies.

www.cervicalspine.com accessed on 12-09-2004.

7. Cervical spondylitis www.g2bclinic.com/english/ayurvedic/ayu_therapy.htm

8. a) Sushrutha, Sushruthasamhitha Chikitsasthana chapter 5. sloka 20, Varanasi: Chaukhamba Orientalia series; 1980. p. 428. b)Bhavamishra, Bhavaprakasha Madyamakanda chapter 24 sloka 76, 5th

edition Varanasi: Chaukhamba Sanskrit series:130,1988. P. 235. c) Chakrapanidatha, chakridatta, vatavyadhi, chikitsi chapter 22, sloka 18 Brahmashankara mishra editor varanasi: chaukhamba Sanskrit series 1976. P.174 (Haridas Sanskrit 107)

9. Agnivesa, charakasamhita sutrasthana chapter 3 sloka18, 4th edition varanasi Chaukhamba Sanskrit sansthan: 2005 P.28 (kasisanskrit series)

10. Chakrapanidatha, chakridatta, vatavyadhi, chikitsi chapter 22, sloka 18

Brahmashankara mishra editor varanasi: chaukhamba Sanskrit series 1976. P.174 (Haridas Sanskrit 107)

11. Sushrutha, Sushruthasamhitha chikitsa sthana chapter 5 sloka 20. Varanasi: Krishnadas Academy; 1980. p. 428-29 (Krishnadas Ayurveda series 51).

12. Ashtangasangraha Suthrasthana chapter 29 slok16.Prof.K.R.Srikhantamurthy editor.Varanasi: Chaukhambha Orientalia; 1996. p.248-49 (Jaikrishnadas Ayurvedic series 79)

13. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 14. sloka 21, Varanasi:

http://www.cervicalspine.com/

http://www.g2bclinic.com/english/ayurvedic/ayu_therapy.htm



Krishnadas Academy; 8th ed. 2005 P. 554.

14. Bhavamishra, Bhavaprakasha Purvakanda chapter 5 sloka 189, 5th

edition Varanasi: Chaukhamba Sanskrit series:130,1988. P. 235. 15. Vagabhatta, Astangasamgraha with sasilekha teeka sutrastana chapter 29 sloka 1, Rudra parasava 1st ed 2006 Varanasi Chaukhamba Krishnadas Academy. P.223 16. Agnivesa charaka samhita siddisthana chapter 9 sloka 89-92 Varanasi: Chowkambha Sanskrit series reprint 2005 P 722. 17. Agnivesa charaka samhita siddisthana chapter 9 sloka 89 Varanasi: Chowkambha Sanskrit series reprint 2005 P 722. 18. Agnivesa charaka samhita vimanasthana chapter 8 sloka 151 P.286 Varanasi: Chowkambha Sanskrit series reprint 2005 P 722. 19. Sushrutha, sushrutha samhitha sutrasthana chapter 40 sloka 21. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.554. 20. Sushrutha, sushrutha samhitha sutrasthana chapter 40 sloka 21. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.554. 21. Vagabhatta, Astangasamgraha with sasilekha teeka sutrastana chapter 29 sloka 2, Rudra parasava 1st ed 2006 Varanasi Chaukhamba Krishnadas Academy. P.223 22. Vagabhatta, Astangasamgraha with sasilekha teeka sutrastana chapter 29 sloka 7, Rudra parasava 1st ed 2006 Varanasi Chaukhamba Krishnadas Academy. P. 223 23. Vagabhatta , Astanga hrydaya sustrastana chapter 20 sloka2, 8th ed. Edited by Vaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 P.287. 24. a)Vrudhajeevaka kashyapasamhita siddisthana chapter 4 sloka 2 4th ed. Varanasi: Chowkambha Sanskrit sansthan; 1988 b) Vrudhajeevaka kashyapasamhita siddisthana chapter 4 sloka 2 4th ed. Varanasi: Chowkambha Sanskrit sansthan; 1988 25. a) Sharangadhara, Sharangadhara samhita Utharakhanda Chapter 8, sloka 2, 6th

ed. Varanasi: Chowakambha Orientalia 2005 P.339. (Jai. Krishnadas Ayurveda series)

b) Sharangadhara, Sharangadhara samhita Utharakhanda Chapter 8, sloka 11, 6th

ed. Varanasi: Chowakambha Orientalia 2005 P.341. (Jai. Krishnadas Ayurveda series) c) Sharangadhara, Sharangadhara samhita Utharakhanda Chapter 8, sloka 24, 6th

ed. Varanasi: Chowakambha Orientalia 2005 P.342. (Jai. Krishnadas Ayurveda series) 26. Dalhana, Nibandha sangraha teeka on sushrutha samhita Chikitsasthana Chapter 40, Sloka 31, Varanasi, Krishna das Academy 1980. 27. Sushrutha, sushrutha samhitha sutrasthana chapter 40 sloka 28. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.555. 28. Sushrutha, sushrutha samhitha sutrasthana chapter 40 sloka 22. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.555. 29. Sushrutha, sushrutha samhitha sutrasthana chapter 40 sloka 23. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.554. 30. Sushrutha, sushrutha samhitha sutrasthana chapter 40 sloka 36. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.556. 31. Sushrutha, sushrutha samhitha sutrasthana chapter 40 sloka 23. 8th ed. Edited

by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.555.

32. Vagabhatta , Astanga hrydaya sustrastana chapter 20 sloka13-15, 8th ed. Edited by Vaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 P.290. 33. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 24. 8th ed. Edited

by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.555.

34. Vagabhatta, Astangasamgraha with sasilekha teeka sutrastana chapter 29 sloka 7, Rudra parasava 1st ed 2006 Varanasi Chaukhamba Krishnadas Academy. P.223 35. Sharangadhara, Sharangadhara samhita Utharakhanda Chapter 8, sloka 12, 6th

ed. Varanasi: Chowakambha Orientalia 2005 P.341. (Jai. Krishnadas Ayurveda series) 36. Sushrutha, sushrutha samhitha sutrasthana chapter 40 sloka 44. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.556.

37. Sushrutha, sushrutha samhitha sutrasthana chapter 40 sloka 44. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.556. 38. Sharangadhara, Sharangadhara samhita Utharakhanda Chapter 8, sloka 16, 6th

ed. Varanasi: Chowakambha Orientalia 2005 P.341. (Jai. Krishnadas Ayurveda series) 39. Agnivesa, Charaka samhitha, chikitsasthana chapter 5, sloka 49-50, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 P.40. 40. Agnivesa, Charaka samhitha, chikitsasthana chapter 5, sloka 46, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 P.41. 41. Agnivesa, Charaka samhitha, Siddhisthana chapter 9, sloka 117, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 P.723. 42. Vagabhatta, Astangasamgraha with sasilekha teeka sutrastana chapter 29 sloka 19, Rudra parasava 1st ed 2006 Varanasi Chaukhamba Krishnadas Academy. P. 226. 43. Vagabhatta, Astangasamgraha with sasilekha teeka sutrastana chapter 29 sloka 19, Rudra parasava 1st ed 2006 Varanasi Chaukhamba Krishnadas Academy. P. 226. 44. Agnivesa, Charaka samhitha, Siddhisthana chapter 9, sloka 92, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 P.722. 45. Vagabhatta , Astanga hrydaya sustrastana chapter 20 sloka32, 8th ed. Edited by Vaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 P.293. 46. a) Agnivesa, Charaka samhitha, Siddhisthana chapter 9, sloka 92, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 P.722. b) Vagabhatta , Astanga hrydaya sustrastana chapter 20 sloka 2, 8th ed. Edited by Vaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 P.287. 47. Agnivesa, Charaka samhitha, Siddhisthana chapter 9, sloka 58, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 P.720. 48. Sushrutha, sushrutha samhitha sutrasthana chapter 40 sloka 23. 8th ed. Edited

by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.555. 49. Vagabhatta, Astangasamgraha with sasilekha teeka sutrastana chapter 29 sloka5, Rudra parasava 1st ed 2006 Varanasi Chaukhamba Krishnadas Academy. P. 223. 50. Agnivesa, Charaka samhitha, Vimanasthana chapter 8, sloka 139, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 P.284. 51. Agnivesa, Charaka samhitha, Siddhisthana chapter 9, sloka 94, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 P.722. 52. Agnivesa, Charaka samhitha, Siddhisthana chapter 2, sloka 23, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 P.690. 53. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 24. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.555. 54. Sharangadhara, Sharangadhara samhita Utharakhanda Chapter 8, sloka 3, 6th

ed. Varanasi: Chowakambha Orientalia 2005 P.339. (Jai. Krishnadas Ayurveda series) 55. Vagabhatta , Astanga hrydaya sustrastana chapter 20 sloka 15-16, 8th ed. Edited byVaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 P.290. 56. Vagabhatta, Astangasamgraha with sasilekha teeka sutrastana chapter 29 sloka16, Rudra parasava 1st ed 2006 Varanasi Chaukhamba Krishnadas Academy. P. 225. 57. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 42. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.556. 58. Vagabhatta , Astanga hrydaya sustrastana chapter 20 sloka 9, 8th ed. Edited byVaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 P.289. 59. Sharangadhara, Sharangadhara samhita Utharakhanda Chapter 8, sloka 21, 6th

ed. Varanasi: Chowakambha Orientalia 2005 P.342. (Jai. Krishnadas Ayurveda series) 60. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 25. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.555.

61. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 25. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.555. 62. Agnivesa, Charaka samhitha, Siddhisthana chapter 9, sloka 98-104, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 P.723. 63. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 25-26 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.555. 64. Vagabhatta , Astanga hrydaya sustrastana chapter 20 sloka 17-20, 8th ed. Edited byVaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 P.290. 65. Vagabhatta, Astangasamgraha with sasilekha teeka sutrastana chapter 29 sloka17, Rudra parasava 1st ed 2006 Varanasi Chaukhamba Krishnadas Academy. P. 226. 66. Agnivesa, Charaka samhitha, Siddhisthana chapter 9, sloka 98-104, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 P.723. 67. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 31. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.556. 68. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 42. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.556. 69. Agnivesa, Charaka samhitha, Siddhisthana chapter 1, sloka 52, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 P.685. 70. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 39. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.556. 71. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 35. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.556. 72. Vagabhatta , Astanga hrydaya sustrastana chapter 20 sloka 23-24, 8th ed. Edited byVaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 P.292. 73. Agnivesa, Charaka samhitha, Siddhisthana chapter 1, sloka 52, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha

surabharathi Prakashanam 2005 P.685. 74. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 34. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.556. 75. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 49. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.557. 76. Agnivesa, Charaka samhitha, Siddhisthana chapter 9, sloka 113-115, reprint 2005. edited by Vaidya Yadawaji trikamji acharya. Varanasi: Chowakambha surabharathi Prakashanam 2005 P.723. 77. Vagabhatta , Astanga hrydaya sustrastana chapter 20 sloka 21, 8th ed. Edited byVaidya Bhisagacharya Harishastri Paradaka . Varanasi: Chowkambha Orientalia 1998 P.291. 78. Vagabhatta, Astangasamgraha with sasilekha teeka sutrastana chapter 29 sloka3, Rudra parasava 1st ed 2006 Varanasi Chaukhamba Krishnadas Academy. P. 223. 79. Sushrutha, sushrutha samhitha Shareerasthana chapter 6 sloka 27. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.374. 80. Sushrutha, sushrutha samhitha Chikitsasthana chapter 40 sloka 40. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.556. 81. Agnivesa, Charakasamhitha Suthrasthana chapter 14. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 87-92. (Kasi Sanskrit series 228). 82. Bhelacharya, Bhelasamhitha Suthrasthana chapter 23. Girijadayal Shukla editor. Varanasi: Chaukhambha Vidyabhavan; 1959. p. 38-40. 83. Vrudhajeevaka, Kashyapasamhita Suthrasthana chapter 23 sloka 20-21. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 24-29. (Kasi Sanskrit series 154). 84. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 32. Varanasi: Krishnadas Academy; 1980. p. 513-515. (Krishnadas Ayurveda series 51). 85. Vaghbhata, Ashtangasangraha with Sashilekha teeka Suthrasthana chapter 26 Rudraparasava editor. Trichur: Mangalodayam publication; 1913.p. 192-199. 86. Vagbhata, Ashtangahridaya Suthrasthana chapter 17. Varanasi: Krishnadas Academy; 1982. p.253-259. (Krishnadas Academic series 4).

87. a. Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 25-27. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p. 89. (Kasi Sanskrit series 228).

b. Bhelacharya, Bhelasamhitha Chikitsasthana chapter 23. Girijadayal Shukla

editor. Varanasi: Chaukhambha Vidyabhavan; 1959. p. 38-40.

c. Vrudhajeevaka, Kashyapasamhita Suthrasthana chapter 23 sloka 20-21. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 24-29. (Kasi Sanskrit series 154).

d. Dalhana, Nibandhasamgraha teeka on Sushruthasamhitha Chikitsasthana

chapter 32 sloka 12. Varanasi: Krishnadas Academy; 1980. p. 513. (Krishnadas Ayurveda series 51).

e. Vaghbhata, Ashtangasangraha with Sashilekha teeka Suthrasthana chapter 26

sloka 5, Rudraparasava editor. Trichur: Mangalodayam publication; 1913.p. 193.

f. Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 6-7. Varanasi:

Krishnadas Academy; 1982. p.254. (Krishnadas Academic series 4). 88. Sharma P V, Classical age of Indian literature. Varanasi: Chaukhambha Sanskrit Studies; 1972.p. 67. (Chaukhambha Sanskrit Series Volume LXXXV). 89. Sharangadhara, Sharngadharasamhitha Utharakhanda chapter 2. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p. 294. (Jaikrishnadas Ayurveda Granthamala 53). 90. Chakrapanidatta, Chakradatta . P.V.Sharma, editor. Varanasi: Chaukhambha Publishers; 1998. p. 183-214. (Kasi Ayurveda series 17). 91. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 24. 5th ed.Varanasi: Chaukhambha Sanskrit series 130; 1988. p. 227. 92. Govindadasa, Bhaishajyaratnavali chapter 27. 7th ed. Kaviraj Ambikadatta Shastri editor. Varanasi: Chaukhambha Orientalia; 1983. p. 373-417. (Kasi Sanskrit series 152). 93. Yogaratnakara with Vidyotini Hindi commentary Vatavyadhichikitsa sloka 117, Brahmashankar sastry editor. Varanasi: Chaukhambha Sanskrit sansthan; 1988. p. 517.(Kasi Sanskrit series 160). 94. Raja Radhakantha Deva Bahadur, Shabdakalpadruma vol 5, 3rd ed. Varanasi:Chaukambha Sanskrit Series; p. 495.(Chaukambha Samskrita Granthamala-93).

95) Agnivesa, Charakasamhitha Suthrasthana chapter 22 sloka 11. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 120. (Kasi Sanskrit series 228). 96) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 8. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 88. (Kasi Sanskrit series 228). 97) Agnivesa, Charakasamhitha Suthrasthana chapter 22 sloka 11. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 120. (Kasi Sanskrit series 228). 98) Kasture VG, Ayurvediyapanchakarmavigyan chapter 3. 6th ed. Nagpur: Shree Baidyanath Ayurved Bhavan Ltd.; 1998. p. 159. 99) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 20-24. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 89. (Kasi Sanskrit series 228). 100) Sushrutha, Sushruthasamhitha Chikitsasthana chapter 32 sloka 17-19. Varanasi: Krishnadas Academy; 1980. p. 514. (Krishnadas Ayurveda series 51). 101) Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 25-27. Varanasi: Krishnadas Academy; 1982. p.259. (Krishnadas Academic series 4). 102) Sushrutha, Sushruthasamhitha Chikitsasthana chapter 32 sloka 17-19. Varanasi: Krishnadas Academy; 1980. p. 514. (Krishnadas Ayurveda series 51). 103) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 16-19. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 88. (Kasi Sanskrit series 228). 104) Sushrutha, Sushruthasamhitha Chikitsasthana chapter 32 sloka 25. Varanasi: Krishnadas Academy; 1980. p. 515. (Krishnadas Ayurveda series 51). 105) Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 21-24. Varanasi: Krishnadas Academy; 1982. p.258. (Krishnadas Academic series 4). 106) Sushrutha, Sushruthasamhitha Chikitsasthana chapter 32 sloka 25. Varanasi: Krishnadas Academy; 1980. p. 515. (Krishnadas Ayurveda series 51). 107) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 16-19. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 88. (Kasi Sanskrit series 228). 108) Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 21-24. Varanasi: Krishnadas Academy; 1982. p.258. (Krishnadas Academic series 4). 109) Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 21-24. Varanasi: Krishnadas Academy; 1982. p.258. (Krishnadas Academic series 4).

110) Arunadatta, Sarvangasundari teeka on Ashtangahridaya Suthrasthana chapter 17 sloka 15. Varanasi: Krishnadas Academy; 1982. p. 257. (Krishnadas Academic series 4). 111) Hemadri, Ayurvedarasayana teeka on Ashtangahridaya Suthrasthana chapter 17 sloka 15.Varanasi: Krishnadas Academy; 1982. p. 257. (Krishnadas Academic series 4). 112) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 13. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 88. (Kasi Sanskrit series 228). 113) Dalhana, Nibandhasangraha teeka on Sushruthasamhitha Chikitsasthana chapter 32 sloka 22-24. Varanasi: Krishnadas Academy; 1980. p. 514. (Krishnadas Ayurveda series 51). 114) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 14-15. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 88. (Kasi Sanskrit series 228). 115) Sushrutha, Sushruthasamhitha Chikitsasthana chapter 32 sloka 24. Varanasi: Krishnadas Academy; 1980. p. 514. (Krishnadas Ayurveda series 51). 116) Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 16-17. Varanasi: Krishnadas Academy; 1982. p.258. (Krishnadas Academic series 4). 117) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 15. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 88. (Kasi Sanskrit series 228). 118) Agnivesa, Charakasamhitha Suthrasthana chapter 6 sloka 27-32. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 47. (Kasi Sanskrit series 228). 119) Sushrutha, Sushruthasamhitha Chikitsasthana chapter 32 sloka 24. Varanasi: Krishnadas Academy; 1980. p. 514. (Krishnadas Ayurveda series 51). 120) Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 18. Varanasi: Krishnadas Academy; 1982. p.258. (Krishnadas Academic series 4). 121) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 65. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 92. (Kasi Sanskrit series 228). 122) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 66. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 92. (Kasi Sanskrit series 228). 123) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 66. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 92. (Kasi Sanskrit series 228).

124) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 7-8. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 88. (Kasi Sanskrit series 228). 125) Sushrutha, Sushruthasamhitha Chikitsasthana chapter 32 sloka 1. Varanasi: Krishnadas Academy; 1980. p. 513. (Krishnadas Ayurveda series 51). 126) Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 1. Varanasi: Krishnadas Academy; 1982. p.255. (Krishnadas Academic series 4). 127) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 39-40. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 90. (Kasi Sanskrit series 228). 128) Dalhana, Nibandhasangraha teeka on Sushruthasamhitha Chikitsasthana chapter 32 sloka 22. Varanasi: Krishnadas Academy; 1980. p. 514. (Krishnadas Ayurveda series 51). 129) Kasture VG, Ayurvediyapanchakarmavigyan chapter 3. 6th ed. Nagpur: Shree Baidyanath Ayurved Bhavan Ltd.; 1998. p. 164. 130) Vrudhajeevaka, Kashyapasamhita Suthrasthana chapter 23 sloka 26. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 277. (Kasi Sanskrit series 154). 131) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 64. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 92. (Kasi Sanskrit series 228). 132) Dalhana, Nibandhasangraha teeka on Sushruthasamhitha Chikitsasthana chapter 32 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 513. (Krishnadas Ayurveda series 51). 133) Dalhana, Nibandhasangraha teeka on Sushruthasamhitha Chikitsasthana chapter 32 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 513. (Krishnadas Ayurveda series 51). 134) Sushrutha, Sushruthasamhitha Chikitsasthana chapter 32 sloka 14. Varanasi: Krishnadas Academy; 1980. p. 514. (Krishnadas Ayurveda series 51). 135) Sushrutha, Sushruthasamhitha Chikitsasthana chapter 32 sloka 5-7. Varanasi: Krishnadas Academy; 1980. p. 513. (Krishnadas Ayurveda series 51). 115. Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 25-27. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 89. (Kasi Sanskrit series 228). 136) Chakrapani, Ayurvedadeepika teeka on Charakasamhitha Suthrasthana chapter 14 sloka 64. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 92. (Kasi Sanskrit series 228).

137) Dalhana, Nibandhasangraha teeka on Sushruthasamhitha Chikitsasthana chapter 32 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 513. (Krishnadas Ayurveda series 51). 138) Mooss.N.S. Vayaskara, Ayurvedic Treatments of Kerala chapter 1. Kottayam: Vaidyasarathy Publications. 1946. p. 3-12. 139) Keraleeya Chikitsakrama (Malayalam) Chapter 2. Trivandrum: Vasudevavalasam Publications; 1982. p. 5. 140) Keraleeya Chikitsakrama (Malayalam) Chapter 2. Trivandrum: Vasudevavalasam Publications; 1982. p. 6. 141) Keraleeya Chikitsakrama (Malayalam) Chapter 2. Trivandrum: Vasudevavalasam Publications; 1982. p. 6. 142) Keraleeya Chikitsakrama (Malayalam) Chapter 2. Trivandrum: Vasudevavalasam Publications; 1982. p. 6. 143) Keraleeya Chikitsakrama (Malayalam) Chapter 2. Trivandrum: Vasudevavalasam Publications; 1982. p. 7. 144) Keraleeya Chikitsakrama (Malayalam) Chapter 2. Trivandrum: Vasudevavalasam Publications; 1982. p. 8. 145) Keraleeya Chikitsakrama (Malayalam) Chapter 2. Trivandrum: Vasudevavalasam Publications; 1982. p. 9. 146) Keraleeya Chikitsakrama (Malayalam) Chapter 2. Trivandrum: Vasudevavalasam Publications; 1982. p. 9. 147) Keraleeya Chikitsakrama (Malayalam) Chapter 2. Trivandrum: Vasudevavalasam Publications; 1982. p. 10. 148) Namboodiri VMC, Notes on Panchakarma. Mezhathur: Vaidyamadham Vaidyasala; 1960. p. 41. 149) Keraleeya Chikitsakrama (Malayalam) Chapter 2. Trivandrum: Vasudevavalasam Publications; 1982. p. 7. 150) Sushrutha, sushrutha samhitha Sareerasthana chapter 6 sloka 29. 8th ed. Edited by vaidya P.V. Sharma. Varanasi Chowkambha Orentalia 2005 P.375. 151) Agnivesa, Charakasamhitha Chikitsasthana chapter 15 sloka 17. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 514 . (Kasi Sanskrit series 228).

152) Rao Ramasundara M, Sarira rachana vijnana chapter 4. Vijayawada: Susruta opticals;2003.p. 565. 153) Sushrutha, Sushruthasamhitha Shareerasthana chapter 4 sloka 4. Varanasi: Krishnadas Academy; 1980. p. 355. (Krishnadas Ayurveda series 51). 154) Agnivesa, Charakasamhitha Shareerasthana chapter 7 sloka 4. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 337 . (Kasi Sanskrit series 228). 155) Sushrutha, Sushruthasamhitha Suthrasthana chapter 21 sloka 10. Varanasi: Krishnadas Academy; 1980. p. 101. (Krishnadas Ayurveda series 51). 156) Martini.F.H, Fundamentals of Anatomy and Physiology chapter 5. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 148. 157) Agnivesa, Charakasamhitha Chikitsasthana chapter 15 sloka 18. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 515 . (Kasi Sanskrit series 228). 158) Agnivesa, Charakasamhitha Shareerasthana chapter 7 sloka 15. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 339 . (Kasi Sanskrit series 228). 159) Agnivesa, Charakasamhitha Shareerasthana chapter 7 sloka 16. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 339 . (Kasi Sanskrit series 228). 160) Vaghbhata, Ashtangasangraha with Sashilekha teeka Suthrasthana chapter 20 sloka 3. Rudraparasava editor. Trichur: Mangalodayam publication; 1913. p. 147. 161) Sushrutha, Sushruthasamhitha Suthrasthana chapter 15 sloka 2. Varanasi: Krishnadas Academy; 1980. p. 68. (Krishnadas Ayurveda series 51). 162) Vagbhata, Ashtangahridaya Suthrasthana chapter 11 sloka 5. Varanasi: Krishnadas Academy; 1982. p.173. (Krishnadas Academic series 4). 163) Agnivesa, Charakasamhitha Vimanasthana chapter 5 sloka 8. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 251 . (Kasi Sanskrit series 228). 164) Agnivesa, Charakasamhitha Vimanasthana chapter 5 sloka 22. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 252 . (Kasi Sanskrit series 228). 165) Agnivesa, Charakasamhitha Vimanasthana chapter 5 sloka 8. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 251 . (Kasi Sanskrit series 228). 166) Shastri ramagopal, Vedom main Ayurved, Delhi:Madanmohanlal Ayurveda anusthana trust;1956. p. 63. 167) Agnivesa, Charakasamhitha Siddhisthana chapter 9 sloka 6. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 717 (Kasi Sanskrit series 228)).

168) Vagbhata, Ashtangahridaya Nidanasthana chapter 15 sloka 23-4 Varanasi: Krishnadas Academy; 1982. p. 532. (Krishnadas Academic series 4). 169) Vagabhata, Ashtangasangraha Suthrasthana chapter 29 sloka 16. Prof.K.R.Srikhantamurthy editor. Varanasi: Chaukhambha Orientalia; 1996. p. 248-49 (Jaikrishnadas Ayurvedic series 79). 170) Dalhana nibandasangraha , Sushruthasamhitha nidanasthana chapter 67 sloka 8-9. Varanasi: Krishnadas Academy; 1980. p. 267. (Krishnadas Ayurveda series 51).). 171) Dalhana nibanda samgraha teeka on Sushruthasamhitha Nidanasthana chapter 67 sloka 8-9. Varanasi: Krishnadas Academy; 1980. p. 267-8. (Krishnadas Ayurveda series 51).). 172) Madhavakara, Madhavanidana chapter 22 sloka 52. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 537. (Chaukhambha Ayurvijnana Granthamala 46). 173) Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 24 sloka 75 5th ed. Varanasi: Chaukhambha Orientalia; 1988. p. 235. (Chaukhambha Sanskrit series 130). 174) Sharangadhara, Sharngadharasamhitha Utharakhanda nasyavidhi 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p. 335 (Jaikrishnadas Ayurveda Granthamala 53). 175) Chakrapanidatta, Chakradatta. Vatavyadhi Chikitsa P.V.Sharma, editor. Varanasi: Chaukhambha Publishers; 1998. p. 160. (Kasi Ayurveda series 17). 176) Vangasena, Vangasenasamhitha vatavyadhi sloka 186-190. Jain Sankarlalji Vaidya editor. Mumbai: Khemnath Srikrishnadas publishers; 1996. p. 332 177) Govindadasa, Bhaishajyaratnavali Vatavyadhi prakarana.sloka-14 7th ed. K. Ambikadatta Shastri editor. Varanasi: Chaukhambha Orientalia; 1983. p. 6 (Kasi Sanskrit series 152). 178) Kelly William, Textbook of Rheumatology chapter 89. 5th ed. Philadelphia: WB Saunders Company; 1997. p. 1230-32. 179) Raja Radhakantha Deva Bahadur, Shabdakalpadruma vol 3, 3rd ed. Varanasi:Chaukambha Sanskrit Series; p. 630.(Chaukambha Samskrita Granthamala-93). 180) Williams Monier Monier Sir, Sanskrit English Dictionary cognate Indo-European languages. New Delhi: Motilal Banarasi Das; 1970. p. 789

181) Vagbhata, Ashtangahridaya Nidanasthana chapter 16 –sloka 47 Varanasi: Krishnadas Academy; 1982. p. 539 (Krishnadas Academic series 4). 182) B.D Chaurasia Human Anatomy 3rd ed. Vol-3 1995.CBS publishers and distributors New Delhi p. 59. 183) Martini.F.H, Fundamentals of Anatomy and Physiology chapter 7. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 218 184) Peter. L. Williams Grays Anatomy Chapter 6. 38 th ed. Philadelphia: Churchill Living Stone; 2000. p. 429-40 185) B.D Chaurasia Human Anatomy 3rd ed. Vol-3 1995.CBS publishers and distributors New Delhi p. 59. 186) Martini.F.H, Fundamentals of Anatomy and Physiology chapter 7 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 219. 187) Ashtangasangraha Suthrasthana chapter 1 sloka 32 Prof.K.R.Srikhantamurthy editor. Varanasi: Chaukhambha Orientalia; 1996. p. 10. (Jaikrishnadas Ayurvedic series 79). 188) Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 17. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p .616,617. (Kasi Sanskrit series 228)). 189) Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 7. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p .615. (Kasi Sanskrit series 228)). 190) Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 17. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 616,617. (Kasi Sanskrit series 228). 191) Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 17. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 616,617. (Kasi Sanskrit series 228). 192) Sushrutha, Sushruthasamhitha Shareerasthana chapter 6 sloka 19. Varanasi: Krishnadas Academy; 1980. p . 370-375. (Krishnadas Ayurveda series 51). 193) Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 17. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 616,617. (Kasi Sanskrit series 228). 194) Sushrutha, Sushruthasamhitha Nidanasthana chapter 1 sloka 67. Varanasi: Krishnadas Academy; 1980. p.267. (Krishnadas Ayurveda series 51). 195) Madhavakara, Madhavanidana chapter 22 sloka 51-52. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 436. (Chaukhambha Ayurvijnana Granthamala 46).

196) Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 24 sloka 74-75 5th ed. Varanasi: Chaukhambha Orientalia; 1988. p. 235. (Chaukhambha Sanskrit series 130). 197) Yogaratnakara –Vatavyadhi chikitsa sloka 63 Vaidya Lakshmipatisastry, editor. Varanasi Chaukhambha Sanskrit Sansthan; 1988. p 403. (Kasi Sanskrit series 160). 198) Sushrutha, Sushruthasamhitha Nidanasthana chapter 1 sloka 67. Varanasi: Krishnadas Academy; 1980. p. 267. (Krishnadas Ayurveda series 51). 199) Madhavakara, Madhavanidana chapter 22 sloka 51. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 436. (Chaukhambha Ayurvijnana Granthamala 46). 200) Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 24 sloka 74-75. 5th ed. Varanasi: Chaukhambha Orientalia; 1988. p. 235. (Chaukhambha Sanskrit series 130). 201) Yogaratnakara – Vatavyadhi chikitsa sloka 63 Vaidya Lakshmipatisastry, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 403. (Kasi Sanskrit series 160). 202) G.S Sainani A.P.I textbook of medicine section XVII Rheumatology. 6th ed. Mumbai:Association of Physicians of India. p. 829. 203) Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 19. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 616,617. (Kasi Sanskrit series 228) 204) Madhavakara, Madhavanidana chapter 1 sloka 7. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 39. (Chaukhambha Ayurvijnana Granthamala 46). 205) www.spineuniverse.com accessed on 18/08/2004 206) http: // emuguidemaps.homesstad.com 207) www.fontynmedical.be/scripts/deatails 208) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 673. 209) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 584. 210) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 248. 211) a) Shastry J.L.N Dravyaguna Vijanam vol 2 Ist edition Varanasi, Chaukhamba Orientalia, 2004 pg. 705.

b) Nadkarni K.M Dr, Indian Meteria Medica Vol 1 3rd edition Bombay, Popular prakashan 1976. pg 939. 212) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 525. 213) a) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 629-630. b) Dr. Gyanendra pandey, Dravya guna vijana part 3. 2nd ed. Varanasi: Chaukhamba Krishnadas academy 2002 p. 621-623. c) Nadkarni K.M Dr, Indian Meteria Medica Vol 1 3rd edition Bombay, Popular prakashan 1976. p. 1126-1127. 214) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 350. 215) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 479. 216) a) Dr. Gyanendra pandey, Dravya guna vijana part 3. 2nd ed. Varanasi: Chaukhamba Krishnadas academy 2002 p. 428-429. b) Nadkarni K.M Dr, Indian Meteria Medica Vol 1 3rd edition Bombay, Popular prakashan 1976. p. 935-936. 217) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 468. 218) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 706. 219) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 455. (Varanasi Ayurveda series). 220) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 221. (Varanasi Ayurveda series). 221) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 469. (Varanasi Ayurveda series). 222) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 223. (Varanasi Ayurveda series). 223) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 225. (Varanasi Ayurveda series).

224) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 820. (Varanasi Ayurveda series). 225) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 822. (Varanasi Ayurveda series). 226) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 822. (Varanasi Ayurveda series). 227) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 283. (Varanasi Ayurveda series). 228) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 632. (Varanasi Ayurveda series). 229) Vagbhatta, Ashtangasangraha Suthrasthana chapter 6 sloka (94-96). Prof.K.R.Srikhantamurthy editor. Varanasi: Chaukhambha Orientalia; 1996. (Jaikrishnadas Ayurvedic series 79). 230) Vagbhatta, Ashtangasangraha Suthrasthana chapter 6 sloka (52-53). Prof.K.R.Srikhantamurthy editor. Varanasi: Chaukhambha Orientalia; 1996. (Jaikrishnadas Ayurvedic series 79). 231) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 569. (Varanasi Ayurveda series). 232) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 292. (Varanasi Ayurveda series). 233) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 39. (Varanasi Ayurveda series). 234) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 202. (Varanasi Ayurveda series). 235) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 365. (Varanasi Ayurveda series). 236) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 562. (Varanasi Ayurveda series). 237) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 632. (Varanasi Ayurveda series). 238) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 275. (Varanasi Ayurveda series).

239) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 359. (Varanasi Ayurveda series). 240) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 745. (Varanasi Ayurveda series). 241) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 747. (Varanasi Ayurveda series). 242) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 365. (Varanasi Ayurveda series). 243) Sharma. PV, Dravyagunavigyan vol 2. 5th ed.Varanasi: Chaukhambha Bharathi Academy;1981. p. 253. (Varanasi Ayurveda series).

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M F

Poor Middle Aristocrat

Hindu Muslim Christian Others

Sedentary Active Labor Others

Date of Schedule Completion : 11. Result: 12. Consent: I here by agree that, I have been fully educated with the disease and

Good Response

Moderate Response

Poor Response

No Response

treatment, here by satisfied whole heartedly, and accept the medical trial over

me.

Investigator’s Signature Patient’s

Signature

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I. Main Complaints Duration

a) Ruk

b) Sthamba

II. Associated Complaints Duration

a) Numbness and Arms ( ) Hands ( ) Fingers ( ) Tingling Sensation

b) Muscle weakness and Shoulder ( ) Arms ( ) Hands ( ) Fingers ( )

Deterioration

c) Headache 1-2 times per month

1-2 times per week Daily but intermittent pain

Continuous pain

d) Crunching sounds Movement of the neck

Movement of the Shoulder muscles

Flexion ( ) Bending

Extension ( ) Rt. Lateral Lt.

Lateral

III. HISTORY OF PRESENT ILLNESS:

Mode of onset Chronic ( ) Insidious ( ) Acute ( ) Traumatic ( )

Nature of pain Pricking ( ) Aching ( ) Generalized ( )

Tearing ( ) Burning ( )

Variation of pain Increased on use ( ) Increased on disuse ( ) Nocturnal ( )

Routine activities affected Yes ( ) No ( )

IV. HISTORY OF PAST ILLNESS:

V. TREATMENT HISTORY:

Modern Medicine ( ) Ayurveda Medicine/Therapy ( )

Other Systems ( ) Relief with previous treatment ( )

VI. FAMILY HISTORY RELEVANT:

If Yes, specify the relation

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VI. Vayaktika vruttanta : 1 Ahāra Vegetarian ( ) Non Vegetarian ( ) 2 Vihāra Nature of work : Hard ( ) Moderate ( ) Sedentary ( ) 3 Agni Samāgni ( ) Mandāgni ( ) Teekshāgni ( ) vishamāgni ( ) 4 Kostha Mrudu ( ) Madhyama ( ) Krura ( ) 5 Nidra Prākruta ( ) Alpa ( ) Ati ( ) Diwāswapna ( ) 6 Vyasana None ( ) Tobacco ( ) Smoking ( ) Alcohol ( ) 7 Artava Regular ( ) Irregular ( ) Menopause ( )

Samanya Pareeksha

A. Asta sthāna Pareeksha : B. Vital examination

VII. Dasha vidha Pareekshā :

1 Nadi /Min 2 Mala 3 Mootra 4 Jihwa 5 Shabda 6 Sparsha 7 Druk 8 Akruti

1 Heart Rate /min 2 Resp. rate /min 3 Blood Pressure mm of Hg4 Body Temp / F5 Body weight Kgs.

1 Prakruti V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) Sama ( )

2 Sāra Pravara. ( ) Madhyama. ( ) Avara ( )

3 Samhanana Pravara ( ) Madhyama. ( ) Avara ( )

4 Pramana Pravara ( ) Madhyama. ( ) Avara ( )

5 Sātmya Ekarasa. ( ) Sarva rasa ( ) Vyamishra ( )

Rooksha satmya ( ) Snigda satmya ( )

6 Satva Pravara ( ) Madhyama ( ) Avara ( )

7 Ahara Shakti a) Abhyavaharana shakti P ( ) M ( ) A ( )

b) Jarana shakti P ( ) M ( ) A ( )

8 Vyayam Shakti Pravara ( ) Madhyama ( ) Avara ( )

9 Vaya Bala ( ) Yuva ( ) Vrudda ( )

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VIII. SROTOPAREEKSHA

Srotas Observed Lakshana

Pranavaha

Annavaha

Udakavaha

Rasavaha

Rakthavaha

Mamsavaha

Medovaha

Asthivaha

Majjavaha

Sukravaha

Pureeshavaha

Muthravaha

Swedovaha

Aarthavavaha

IX. NIDAANAPAREEKSHA a. Aahaara

Tiktharasa Athyupayoga Kashayarasa Athyupayoga Katurasa Athyupayoga

Alpa Bhojana Pramitha Bhojana Rooksha Bhojana

b. Vihaara

Vega Dhaarana Vegoodeerana Ativyavaya

Nisaajaagarana Atyucha Bhaashana Ativyaayama

c. Maanasika

Atibhaya Atishoka Atichintha

d. Occupational

e. Chikitsa Aparaadhaja

Shodhanakarma Atiyogaja Yes No

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2. Poorvarupa :

3. Upashaya/Anupashaya :

Ushna Seetha

Rooksha Snigdha

4. Rupa :

5. Samprapthi :

X SAADHYAASAADHYATA: XI NIDANA

AAHARA VIHARA MANASIKA

Katu Rasa Asamasthana sayanam Chinta

Tikta Rasa Urdhwa Nireekshanam Shoka

Kashaya Rasa Diva swapnam Bhaya

Ati Sheeta Vyayama VYASANA

Ati Rooksha Langhana Madhya Pana

Alph Ahara Plavana Dhooma Pana

Laghu Ahara Adhvagamana Tobacco Chewing

NIDRA Yanam

Vishama Upachara

Prajagara

XII SPECIAL EXAMINATION

A. Pain a). Onset Sudden ( )

Gradual ( ) b). Site Cervical ( )

Cervico thoracic ( ) Shoulder ( ) c). Nature of pain Localised ( )

Radiated ( ) Vague ( )

c) MOBILITY OF CERVICAL

JOINT

Before After

Flexion

Extension

Rt. Lateral

Bending Lt. Lateral

Rotation Intermittent ( ) Continues ( )

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d). Duration Since e). Severity

1 2 3 4 5 Grade (Grade 0: No pain, Grade 1: Mild pain, Grade 2: More than mild pain but

tolerable, Grade 3: Moderately severe pain , Grade 4: Severe pain, Grade 5: Intolerable, perhaps suicidal pain)

f). Aggravating Movement ( ) Rest ( ) g). Relieving factor Rest ( ) Pain relievers ( ) Tranquillizes ( ) Pressure

( )

0 1 2 3 II). Stiffness of neck III) Tenderness 1 2 3 (Huckstep tender triad)

IV. Dizziness; while

a) DARSANA Before After

Swelling

Redness

Muscle waisting

b) SPARSANA

Warmth over joint (t0)

Tenderness

Bony component palpable

INVESTIGATIONS X-RAY FINDINGS

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TREATMENT PROTOCOL

I Group A :- Choorna pinda swedam Day Time Duration Observation Advise 1 2 3 4 5 6 7 I Group B :- (Choorna pinda swedam followed by Nasyam) Day Time Duration Observation Advise 1 2 3 4 5 6 7 III Nasyam :- Day Matra 8 Bindu Time of

Performance Observation Advise

1 2 3 4 5 6 7

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XII. ASSESSMENT OF RESULTS

A. SUBJECTIVE PARAMETERS

Parameters Before Treatment After Treatment

Ruk (Pain)

Graha (Stiffness)

OBJECTIVE PARAMETERS

PARAMETER B. T. A. T.

Pain Grade

Stiffness

Numbness

Flexion

Extension

Rt. Lateral

Mobility

of

cervical

spine Lt Lateral

Passive neck flexion

Muscle strength

B. NASYAKAARMUKATA PARAMATERS. Parameters Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Sukhauchvasam

Sukha

swapanam

Sukha Bodha

Akshipadavam

Sukhauchvasam

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C. SWEDAKAARMUKATA PARAMETERS

Parameters Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Agnideepthi

Bhakthasradha

Tandraahaani

Sandhicheshta

Srotonirmalatva

Parameters Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Maardava

Tvak Prasada

INVESTIGATOR’S NOTE:

SIGNATURE OF GUIDE SIGNATURE OF THE SCHOLAR

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1) Pain grade : 1) Grade O: No Pain, 1: Mild Pain, 2) More than Mild Pain but tolerable 3) Moderately sever pain 4) Sever pain S: Intolerable perhaps suicidal pain 2) Stiffness grade : (No Movement =0, Upto 50% =1 50 – 70% =2, > 70% ad full range =3 Full range =4) 3) Mobility grade : No Movement =0, Upto 50%=1, 50-70%=2, >70%, and full range=3, Flexion:-0, No movement, Full range – up to chin Touches (300) Extension –0, No movement, Full range -300,

Lateral flexion :-0 No movement, Full range -400, Rotation: 0, No movement, Full range - 700 to 900

Nasya manyasthambha pk014-gdg

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